Provider Demographics
NPI:1407837990
Name:ALTWERGER, RICHARD A (DPM)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:ALTWERGER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1528 COLUMBIA TPKE
Mailing Address - Street 2:SUITE102
Mailing Address - City:CASTLETON
Mailing Address - State:NY
Mailing Address - Zip Code:12033-9584
Mailing Address - Country:US
Mailing Address - Phone:518-479-3338
Mailing Address - Fax:518-479-3358
Practice Address - Street 1:1528 COLUMBIA TPKE
Practice Address - Street 2:SUITE102
Practice Address - City:CASTLETON
Practice Address - State:NY
Practice Address - Zip Code:12033-9584
Practice Address - Country:US
Practice Address - Phone:518-479-3338
Practice Address - Fax:518-479-3358
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0031701213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00703957Medicaid
NY00703957Medicaid
NY1689687337Medicare NSC
NY1407837990Medicare NSC