Provider Demographics
NPI:1497708275
Name:ALTHAUS, DAVID P (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:P
Last Name:ALTHAUS
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 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-446-5804
Mailing Address - Fax:740-446-5150
Practice Address - Street 1:2619 STATE ROUTE 850
Practice Address - Street 2:
Practice Address - City:BIDWELL
Practice Address - State:OH
Practice Address - Zip Code:45614-9288
Practice Address - Country:US
Practice Address - Phone:740-446-5148
Practice Address - Fax:740-446-5150
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-3575207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000190710OtherUNISON MEDICAID
000000007209OtherANTHEM BCBS
001714078OtherMOUNTAIN STATE BCBS
OH220010796OtherRR MEDICARE
WV0102680000Medicaid
WV220010795OtherRR MEDICARE
OH0885001OtherMOLINA MEDICAID
000000007209OtherANTHEM BCBS
OH000000190710OtherUNISON MEDICAID
OH220010796OtherRR MEDICARE
WV0102680000Medicaid