Provider Demographics
NPI:1578635132
Name:ALTMAN, MYRA (MD)
Entity Type:Individual
Prefix:MS
First Name:MYRA
Middle Name:
Last Name:ALTMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:16 FAHEY STREET
Mailing Address - Street 2:SUITE 107
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915
Mailing Address - Country:US
Mailing Address - Phone:207-338-1854
Mailing Address - Fax:207-338-1555
Practice Address - Street 1:16 FAHEY STREET
Practice Address - Street 2:SUITE 107
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915
Practice Address - Country:US
Practice Address - Phone:207-338-1854
Practice Address - Fax:207-338-1555
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME012101207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E001925OtherTRICARE
079090OtherANTHEM BC BS
AA21980OtherHARVARD PILGRIM
MEMM0636Medicare ID - Type Unspecified
079090OtherANTHEM BC BS