Healthcare Provider Details

I. General information

NPI: 1801790415
Provider Name (Legal Business Name): ALTEA MEDICAL MARYLAND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 FURNACE ST
CUMBERLAND MD
21502-1564
US

IV. Provider business mailing address

400 E RIVULON BLVD STE 103
GILBERT AZ
85297-0096
US

V. Phone/Fax

Practice location:
  • Phone: 301-777-5941
  • Fax:
Mailing address:
  • Phone: 888-408-7008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: LISA KRUEGER
Title or Position: VP OF RCM AND CONTRACTING
Credential:
Phone: 888-408-7008