Individual
DR. DIANE LOUISE FOUNTAS
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1389 W MAIN ST, SUITE 325, WATERBURY, CT 06708-3104
(203) 753-6776
(203) 573-1875
Mailing address
1389 W MAIN ST, SUITE 325, WATERBURY, CT 06708-3104
(203) 753-6776
(203) 573-1875
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
024436
CT
Other
Enumeration date
04/14/2006
Last updated
07/09/2007
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