Organization
BEV FONTAINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. HOSSIEN TALEBIAN (BILLING MANAGER)
(703) 955-4923
Entity
Organization
Contact information
Practice address
5550 FRIENDSHIP BLVD STE 360, CHEVY CHASE, MD 20815-7256
(240) 341-1290
Mailing address
1410 POWELLS TAVERN PL, HERNDON, VA 20170-5712
(703) 955-4923
(703) 444-3610
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0101265585
VIRGINIA PHYSICIAN LICENSE
VA
01
—
D85002
MARYLAND PHYSICIAN LICENSE
MD
01
—
M94766
CDS REGISTRATION
MD
01
—
MD042654
DC PHYSICIAN LICENSE
DC
Enumeration date
12/30/2019
Last updated
03/07/2023
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