Provider Demographics
NPI:1487424503
Name:FOUNTAIN HANNA, MONIQUE ROCHELLE (MD)
Entity type:Individual
Prefix:DR
First Name:MONIQUE
Middle Name:ROCHELLE
Last Name:FOUNTAIN HANNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MONIQUE
Other - Middle Name:ROCHELLE
Other - Last Name:FOUNTAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:211 SIR TEDDY WAY
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-4905
Mailing Address - Country:US
Mailing Address - Phone:301-641-2743
Mailing Address - Fax:
Practice Address - Street 1:211 SIR TEDDY WAY
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-4905
Practice Address - Country:US
Practice Address - Phone:301-641-2743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4198042083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine