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1518965292 NPI number — KELLY A FONTANA MD

NPI Number: 1518965292
Health Care Provider/Practitioner: KELLY A FONTANA MD

Information about “1518965292” NPI (KELLY A FONTANA MD) exists in 1518965292 in HTML format HTML  |  1518965292 in plain Text format TXT  |  1518965292 in PDF (Portable Document Format) PDF  |  1518965292 in an XML format XML  formats.

NPI Number : 1518965292 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1518965292",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "FONTANA",
    "FirstName": "KELLY",
    "MiddleName": "A",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1585 PINE RIDGE RD",
    "SecondLineMailingAddress": "SUITE 2",
    "MailingAddressCityName": "NAPLES",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "34109-2105",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "239-451-3143",
    "MailingAddressFaxNumber": "239-451-3145",
    "FirstLinePracticeLocationAddress": "1585 PINE RIDGE RD",
    "SecondLinePracticeLocationAddress": "SUITE 2",
    "PracticeLocationAddressCityName": "NAPLES",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "34109-2105",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "239-451-3143",
    "PracticeLocationAddressFaxNumber": "239-451-3145",
    "EnumerationDate": "07/07/2005",
    "LastUpdateDate": "03/25/2016",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207R00000X",
          "TaxonomyName": "Internal Medicine Physician",
          "LicenseNumber": "ME98117",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "208000000X",
          "TaxonomyName": "Pediatrics Physician",
          "LicenseNumber": "ME98117",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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