Provider Demographics
NPI:1164596656
Name:ALTMAN, RENEE HUTTO (DPM)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:HUTTO
Last Name:ALTMAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8301 FARROW RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-3245
Mailing Address - Country:US
Mailing Address - Phone:803-935-5103
Mailing Address - Fax:
Practice Address - Street 1:901 12TH ST
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29033-3301
Practice Address - Country:US
Practice Address - Phone:803-796-0616
Practice Address - Fax:803-796-6771
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC518213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP9921Medicaid
SCGP9921Medicaid
SCU687208922Medicare Oscar/Certification