Fontaine, Darryl

Fontaine, Darryl is an individual health care provider with primary practice located at 4105 Fort Henry Drive Suite 207, Kingsport TN 37663. He recently has only one registered license in Allopathic & Osteopathic Physicians / Anesthesiology, which is considered as his primary health care specialty. Fontaine, Darryl can be contacted via phone (423) 239-5833.

Contact Information

Primary practice address
4105 Fort Henry Drive Suite 207 Kingsport TN 37663
Phone: (423) 239-5833
Fax: (423) 239-9789
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Anesthesiology 207L00000X 20124 Tennessee

Profile Details

NPI number 1023000429
LBN Legal business name Fontaine, Darryl
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 22nd, 2005
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1023000429 NPPES
West Virginia MEDICAID 0221312000
West Virginia MEDICAID 890576L
West Virginia Other TN0100
West Virginia Other 3046989
West Virginia MEDICAID 3051034
West Virginia Other 00013859
West Virginia Other 100011235
West Virginia MEDICAID 5747040
West Virginia MEDICAID 64911142
West Virginia Other 063263

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