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General NPI Number Information
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NPI Number | 1750367074
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Entity Type | Individual
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Provider Name | MARY E FONTANA-PENN MD
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Gender | Female
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Dates
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Enumeration Date | 12/19/2005
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Last Update Date | 01/21/2021
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Provider Practice Location Address
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Address Line | 7939 HONEYGO BLVD SUITE 219
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City | NOTTINGHAM
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State | MD
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Zip | 21236-4931
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Country | US
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Telephone | 410-931-0404
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Fax | 410-931-0405
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Provider Business Mailing Address
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Address Line | 5430 CAMPBELL BLVD STE 103
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City | WHITE MARSH
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State | MD
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Zip | 21162-5503
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Country | US
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Telephone | 410-933-9404
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number | D0069408
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License Number State | MD
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