Healthcare Provider Details

I. General information

NPI: 1437478138
Provider Name (Legal Business Name): ADAM A ALTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2010
Last Update Date: 08/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 FODEN RD STE 103
SOUTH PORTLAND ME
04106
US

IV. Provider business mailing address

65 SPRUCE ST
PORTLAND ME
04102-4068
US

V. Phone/Fax

Practice location:
  • Phone: 207-828-1122
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMC22206
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: