Healthcare Provider Details

I. General information

NPI: 1598938177
Provider Name (Legal Business Name): NATASHA NOELLE FONTAINE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NATASHA N FONTAINE

II. Dates (important events)

Enumeration Date: 04/04/2008
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2930 CHESTERFIELD AVE
CHARLESTON WV
25304-1125
US

IV. Provider business mailing address

601 MEMORY LN
YORK PA
17402-2231
US

V. Phone/Fax

Practice location:
  • Phone: 304-351-1700
  • Fax:
Mailing address:
  • Phone: 717-851-1405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD78015
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD457534
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberD78015
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0101271745
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD042469
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: