Fontana, Mark Ambrose

Fontana, Mark Ambrose is an individual health care provider with primary practice located at 6251 E Virginia Beach Blvd Ste 300 , Norfolk VA 23502-2824. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Surgery. Allopathic & Osteopathic Physicians / Surgery is his primary health care specialty. Fontana, Mark Ambrose can be contacted via phone (757) 261-5000.

Contact Information

Primary practice address
6251 E Virginia Beach Blvd Ste 300 Norfolk VA 23502-2824
Phone: (757) 261-5000
Fax: (757) 962-5610
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 0101049884 Virginia
Allopathic & Osteopathic Physicians / Surgery 208600000X 2016-00298 North Carolina
Allopathic & Osteopathic Physicians / Surgery 208600000X 0101049884 Virginia

Profile Details

NPI number 1598769960
LBN Legal business name Fontana, Mark Ambrose
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 13th, 2005
Last updated Apr 23rd, 2021 - about 5 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 1598769960 NPPES
Virginia MEDICAID 010142164

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