Provider Demographics
NPI:1376999458
Name:ALTMAN, BEVERLY (BA)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:
Last Name:ALTMAN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:NC
Mailing Address - Zip Code:28721-8026
Mailing Address - Country:US
Mailing Address - Phone:469-801-3947
Mailing Address - Fax:828-456-8009
Practice Address - Street 1:414 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-8026
Practice Address - Country:US
Practice Address - Phone:469-801-3947
Practice Address - Fax:828-456-8009
Is Sole Proprietor?:No
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator