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NPI Code Detail

MEDICARE: DR. MARK AMBROSE FONTANA MD

MEDICARE: DR. MARK AMBROSE FONTANA MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist0101049884VA
2208600000XSurgery Physician2016-00298NC
3208600000XSurgery Physician0101049884VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1598769960
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK AMBROSE FONTANA MD
Provider Business Mailing Address
First Line : 6251 E VIRGINIA BEACH BLVD STE 300
Second Line :
City : NORFOLK
State : VA
Zip : 23502-2824
Country : US
Telephone Number : 757-261-5000
Fax Number : 757-962-5610
Provider Business Practice Location Address
First Line : 6251 E VIRGINIA BEACH BLVD STE 300
Second Line :
City : NORFOLK
State : VA
Zip : 23502-2824
Country : US
Telephone Number : 757-261-5000
Fax Number : 757-962-5610
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2005
Last Update Date : 04/23/2021

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Directions to “ DR. MARK AMBROSE FONTANA MD” Practice Location

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