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Individual
DR. JOHN R FONTANILLA
Active
Individual
DR. JOHN R FONTANILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MT188798
PA
207RN0300X
Nephrology Physician
Primary
MD445193
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1007278000113
TPI MEDICAID GROUP
PA
01
—
597586
TPI MEDICARE GROUP
PA
01
—
CD4829
TPI RAILROAD MEDICARE GROUP ID
PA
Enumeration date
05/15/2007
Last updated
07/27/2012
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