Organization
DIANE L. FOUNTAS M.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TAMMY CARRASQUILLO (OFFICE MANAGER)
(203) 753-6776
Entity
Organization
Contact information
Practice address
1389 W MAIN ST, SUITE 325, WATERBURY, CT 06708-3104
(203) 753-6776
Mailing address
1389 W MAIN ST, SUITE 325, WATERBURY, CT 06708-3104
(203) 753-6776
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
024436
CT
Other
Enumeration date
07/16/2007
Last updated
07/16/2007
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