Individual
DR. MARK AMBROSE FONTANA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6251 E VIRGINIA BEACH BLVD STE 300, NORFOLK, VA 23502-2824
(757) 261-5000
(757) 962-5610
Mailing address
6251 E VIRGINIA BEACH BLVD STE 300, NORFOLK, VA 23502-2824
(757) 261-5000
(757) 962-5610
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
0101049884
VA
208600000X
Surgery Physician
Primary
0101049884
VA
208600000X
Surgery Physician
2016-00298
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010142164
—
VA
Enumeration date
06/13/2005
Last updated
04/23/2021
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