Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 264068 | NY |
N | 2080P0207X | Pediatric Hematology-Oncologist | 264068 | NY |
NPI | 1306160106 |
---|---|
Provider Name | Dr. Thomas J Fountaine |
First Address | Rochester, NY 14642-0001 |
Second Address | Rochester, NY 14642-3001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2010 |
Last Update Date | 17/03/2018 |