Healthcare Provider Details

I. General information

NPI: 1386755510
Provider Name (Legal Business Name): MARTIN STEVEN ALTSCHUL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5125 SKYLINE RD S
SALEM OR
97306-9427
US

IV. Provider business mailing address

2400 LANCASTER DR NE
SALEM OR
97305-1221
US

V. Phone/Fax

Practice location:
  • Phone: 503-763-5918
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD14181
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: