Provider Demographics
NPI:1134123102
Name:ALTMAN, HOWARD G (MD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:G
Last Name:ALTMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8500-6335
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-6335
Mailing Address - Country:US
Mailing Address - Phone:215-745-1612
Mailing Address - Fax:215-745-8319
Practice Address - Street 1:1342 COTTMAN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-3729
Practice Address - Country:US
Practice Address - Phone:215-745-1612
Practice Address - Fax:215-745-8319
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033441E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30106259OtherKEYSTONE MERCY
PA0303650000OtherKEYSTONE IBC
PA232691968OtherHEALTH PARTNERS
PAP01043216OtherRAILROAD MEDICARE
PA8315369OtherAETNA
PA0011714600005Medicaid
PA178549OtherHIGHMARK BLUE SHIELD
PA0303650000OtherKEYSTONE IBC
PA178549OtherHIGHMARK BLUE SHIELD
PA178549Medicare ID - Type Unspecified