Provider Demographics
NPI:1316028079
Name:ALTIMORE, PATRICIA RYAN (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:RYAN
Last Name:ALTIMORE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:A
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-7260
Mailing Address - Fax:717-292-2879
Practice Address - Street 1:3992 CARLISLE RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:PA
Practice Address - Zip Code:17315-3506
Practice Address - Country:US
Practice Address - Phone:717-851-7260
Practice Address - Fax:717-292-2879
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP004531G363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA210096OtherJOHNS HOPKINS
PA1925507OtherHIGHMARK BLUE SHIELD
MD894728OtherCAREFIRST MD BCBS
PA50065459OtherCAPITAL BLUE CROSS-WMG
PA1559928OtherGATEWAY-WMG
PA1925507OtherHIGHMARK BLUE SHIELD
Q76917Medicare UPIN
PAP00411161Medicare PIN