Provider Demographics
NPI:1689652711
Name:ALTMAN, MARK PHILLIPS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:PHILLIPS
Last Name:ALTMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:322 E MAIN ST STE 1B
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-3136
Mailing Address - Country:US
Mailing Address - Phone:203-488-7228
Mailing Address - Fax:203-488-7227
Practice Address - Street 1:2200 WHITNEY AVE STE 170
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3694
Practice Address - Country:US
Practice Address - Phone:203-408-2700
Practice Address - Fax:203-884-8201
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT38149207XS0106X
CT038149207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1689652711Medicaid
CT200000907Medicare Oscar/Certification
CTD91891Medicare UPIN