Provider Demographics
NPI:1497765572
Name:ALTIERI, RAYMOND JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:JOHN
Last Name:ALTIERI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:314 GERMAN HILL RD
Mailing Address - Street 2:
Mailing Address - City:DUNDALK
Mailing Address - State:MD
Mailing Address - Zip Code:21222-1514
Mailing Address - Country:US
Mailing Address - Phone:410-285-1000
Mailing Address - Fax:410-284-1961
Practice Address - Street 1:314 GERMAN HILL RD
Practice Address - Street 2:
Practice Address - City:DUNDALK
Practice Address - State:MD
Practice Address - Zip Code:21222-1514
Practice Address - Country:US
Practice Address - Phone:410-285-1000
Practice Address - Fax:410-284-1961
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0024602207R00000X, 207RA0401X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD064151100Medicaid
0965501OtherAETNA
16084730032126012OtherCIGNA
E2970001OtherBLUE CHOICE
1137530OtherFIRST HEALTH
41022402OtherUNIVERSAL
0402163OtherUNITED HC
1751RJOtherCARE FIRST BC
410224OtherMDPOS
41960OtherCOVENTRY
E2970001OtherCF BC FED
110195431OtherRAILROAD MED