Healthcare Provider Details

I. General information

NPI: 1568693067
Provider Name (Legal Business Name): AHMET ALTAY M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2009
Last Update Date: 02/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 AMHERST ST
WINCHESTER VA
22601-2808
US

IV. Provider business mailing address

12700 CAMDEN PARK CT
BRISTOW VA
20136-1293
US

V. Phone/Fax

Practice location:
  • Phone: 540-536-4334
  • Fax:
Mailing address:
  • Phone: 571-278-2168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101266766
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number45337
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: