Provider Demographics
NPI:1154845881
Name:ALTIMARE, JILL MEGAN (LDN)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MEGAN
Last Name:ALTIMARE
Suffix:
Gender:F
Credentials:LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N 3RD ST FL 2
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-1869
Mailing Address - Country:US
Mailing Address - Phone:484-503-8010
Mailing Address - Fax:484-503-8009
Practice Address - Street 1:100 N 3RD ST FL 2
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-1869
Practice Address - Country:US
Practice Address - Phone:484-503-8010
Practice Address - Fax:484-503-8009
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered