Individual
MARY ANN FONTANAROSA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2600 STATE ROUTE 5, CORTLAND, OH 44410-9393
(330) 372-8800
(330) 372-8999
Mailing address
2600 ELM RD NE, CORTLAND, OH 44410-9393
(330) 372-8800
(330) 372-8999
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
35050393
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000243195
ANTHEM BC/BS OHIO
OH
01
—
000028496
HIGHMARK BC/BS PA
OH
05
—
0631801
—
OH
01
—
110247884
RAILROAD MEDICARE
OH
01
—
341341025036
CARESOURCE
OH
01
—
400877
UNITED HEALTHCARE
OH
01
—
78933
HEALTH ASSURANCE
OH
01
—
J50393
SUMMACARE
OH
01
—
Q004667
HOMETOWN
OH
Enumeration date
07/17/2006
Last updated
08/02/2018
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