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1730263617

NPI Code Detail

MEDICARE: MARK DAVID ALTER M.D.

MEDICARE: MARK DAVID ALTER 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	MED-PHYS-LIC-48691	MT
2	2084P0804X	Child & Adolescent Psychiatry Physician	036139217	IL
3	2084P0800X	Psychiatry Physician	1745	WI
4	2084P0800X	Psychiatry Physician	C1-0010413	DE
5	2084P0800X	Psychiatry Physician	MD434911	PA
6	2084P0800X	Psychiatry Physician	C161292	CA
7	2084P0800X	Psychiatry Physician	25MA08775500	NJ
8	2084P0800X	Psychiatry Physician	0101259576	VA
9	2084P0800X	Psychiatry Physician	036139217	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730263617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK DAVID ALTER M.D.

Provider Business Mailing Address
First Line	:	765 E ROUTE 70
Second Line	:	BUILDING A
City	:	MARLTON
State	:	NJ
Zip	:	08053-2341
Country	:	US
Telephone Number	:	856-552-4347
Fax Number	:	856-797-4785

Provider Business Practice Location Address
First Line	:	2160 S 1ST AVE
Second Line	:
City	:	MAYWOOD
State	:	IL
Zip	:	60153-3328
Country	:	US
Telephone Number	:	708-216-9000
Fax Number	:

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

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	02/05/2026

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Directions to “ MARK DAVID ALTER M.D.” Practice Location

Language	Start Address	Practice Location

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