Provider Demographics
NPI:1598764433
Name:ALTMAN, DAVID J (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:ALTMAN
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:PO BOX 8000
Mailing Address - Street 2:DEPARTMENT 273
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14267-0002
Mailing Address - Country:US
Mailing Address - Phone:716-810-0610
Mailing Address - Fax:716-810-0630
Practice Address - Street 1:8421 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-4133
Practice Address - Country:US
Practice Address - Phone:716-810-0610
Practice Address - Fax:716-810-0630
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208731207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
9701605OtherGHI
000526696001OtherBC/BS-HEALTHNOW
00025872901OtherUNIVERA
NY0311368OtherINDEPENDENT HEALTH
NY070016621OtherRR MEDICARE
NYH53333Medicare UPIN
9701605OtherGHI