Individual
OLIMPO FERNANDO FONSECA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
134 CECIL D QUILLEN DR, DUFFIELD, VA 24244-9726
(276) 431-1638
(276) 431-1639
Mailing address
RR 3, BIGSTONE GAP, VA 24219
(276) 523-1878
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101031676
VA
Other
Enumeration date
08/11/2006
Last updated
07/08/2007
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