Healthcare Provider Details

I. General information

NPI: 1134353121
Provider Name (Legal Business Name): DIANE LINDA ALTERMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2009
Last Update Date: 06/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 N SALISBURY BLVD
SALISBURY MD
21801-2138
US

IV. Provider business mailing address

2012 HIGHLAND AVE
MANHATTAN BEACH CA
90266-4562
US

V. Phone/Fax

Practice location:
  • Phone: 877-222-4934
  • Fax: 410-334-6352
Mailing address:
  • Phone: 310-546-8819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0002136
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPDO11856
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: