MEDICARE: PHILIP D ALTEKRUSE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	57260	MA
2	2084P0804X	Child & Adolescent Psychiatry Physician	57260	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Y02415	OTHER	MA	BLUE CROSS

General Provider Information

NPI Number	:	1255354049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILIP D ALTEKRUSE M.D.

Provider Business Mailing Address
First Line	:	19 LONGFELLOW RD
Second Line	:
City	:	CAMBRIDGE
State	:	MA
Zip	:	02138-4737
Country	:	US
Telephone Number	:	617-576-0699
Fax Number	:	617-774-1490

Provider Business Practice Location Address
First Line	:	859 WILLARD ST
Second Line	:	SUITE 430
City	:	QUINCY
State	:	MA
Zip	:	02169-7482
Country	:	US
Telephone Number	:	617-847-1950
Fax Number	:	617-774-1490

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	09/11/2025

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