Healthcare Provider Details

I. General information

NPI: 1134123102
Provider Name (Legal Business Name): HOWARD G ALTMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 11/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1342 COTTMAN AVE
PHILADELPHIA PA
19111-3729
US

IV. Provider business mailing address

PO BOX 8500-6335
PHILADELPHIA PA
19178-6335
US

V. Phone/Fax

Practice location:
  • Phone: 215-745-1612
  • Fax: 215-745-8319
Mailing address:
  • Phone: 215-745-1612
  • Fax: 215-745-8319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD033441E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: