Healthcare Provider Details

I. General information

NPI: 1467080929
Provider Name (Legal Business Name): ELLERY ALTSHULER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 ORLEANS ST # 1186
BALTIMORE MD
21287-0013
US

IV. Provider business mailing address

1650 ORLEANS ST # 1186
BALTIMORE MD
21287-0013
US

V. Phone/Fax

Practice location:
  • Phone: 305-389-6231
  • Fax:
Mailing address:
  • Phone: 305-389-6231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number0101288403
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: