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General NPI Number Information
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NPI Number | 1962865220
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Entity Type | Individual
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Provider Name | DANIELLE MARIE FONTAINE MD
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Gender | Female
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Dates
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Enumeration Date | 04/03/2016
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Last Update Date | 03/04/2024
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Provider Practice Location Address
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Address Line | 730 MALCOLM BLVD
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City | CONNELLY SPRINGS
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State | NC
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Zip | 28612-8079
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Country | US
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Telephone | 828-580-3572
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Fax |
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Provider Business Mailing Address
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Address Line | 5221 PARAMOUNT PKWY STE 420
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City | MORRISVILLE
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State | NC
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Zip | 27560-5491
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Country | US
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Telephone | 984-974-2705
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 2022031705
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 2019-00201
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License Number State | NC
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