Provider Demographics
NPI:1598254708
Name:ALTEN, EDWARD DAVID (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:DAVID
Last Name:ALTEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6010 S MASON MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-3706
Mailing Address - Country:US
Mailing Address - Phone:513-246-7000
Mailing Address - Fax:513-204-6351
Practice Address - Street 1:6010 S MASON MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-3706
Practice Address - Country:US
Practice Address - Phone:513-246-7000
Practice Address - Fax:513-204-6351
Is Sole Proprietor?:No
Enumeration Date:2018-05-02
Last Update Date:2023-09-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35.1446712080P0204X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0479131Medicaid