Fontanilla, John R
Fontanilla, John R is an sole proprietor health care provider with primary practice located at 4453 Castor Ave Suite B, Philadelphia PA 19124-3846. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Nephrology. Allopathic & Osteopathic Physicians / Nephrology is his primary health care specialty. Fontanilla, John R can be contacted via phone (215) 744-2266.Contact Information
Primary practice address
4453 Castor Ave Suite B
Philadelphia PA 19124-3846
Phone: (215) 744-2266
Fax: (215) 743-9247
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | MT188798 | Pennsylvania |
| Allopathic & Osteopathic Physicians / Nephrology | 207RN0300X | MD445193 | Pennsylvania |
Profile Details
| NPI number | 1669688412 |
|---|---|
| LBN Legal business name | Fontanilla, John R |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | May 15th, 2007 |
| Last updated | Jul 27th, 2012 - about 13 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1669688412 | NPPES |
| Pennsylvania | Other | 1007278000113 | TPI MEDICAID GROUP |
| Pennsylvania | Other | CD4829 | TPI MEDICAID GROUP |
| Pennsylvania | Other | 597586 | TPI MEDICAID GROUP |
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