Provider Demographics
NPI:1669639779
Name:ALTER, WILLIAM (DO)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:ALTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6147 STATE ROUTE 122 STE 110
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-5201
Mailing Address - Country:US
Mailing Address - Phone:513-261-3500
Mailing Address - Fax:513-261-3509
Practice Address - Street 1:6147 STATE ROUTE 122 STE 110
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45005-5201
Practice Address - Country:US
Practice Address - Phone:513-261-3500
Practice Address - Fax:513-261-3509
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH58.002153390200000X
OH34.009883207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3071125Medicaid