Provider Demographics
NPI:1164659959
Name:ALTMAN, NICHOLAS DODGE (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:DODGE
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 1:20485 CALLON DR
Mailing Address - Street 2:
Mailing Address - City:TOPANGA
Mailing Address - State:CA
Mailing Address - Zip Code:90290-3709
Mailing Address - Country:US
Mailing Address - Phone:213-925-7375
Mailing Address - Fax:
Practice Address - Street 1:924 N FORMOSA AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046-6702
Practice Address - Country:US
Practice Address - Phone:213-925-7375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY264170207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine