Provider Demographics
NPI:1689823932
Name:ALDERFER, JEREMY C (MD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:C
Last Name:ALDERFER
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 1:300 W 5TH ST
Mailing Address - Street 2:APT 634
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-1668
Mailing Address - Country:US
Mailing Address - Phone:704-915-5674
Mailing Address - Fax:
Practice Address - Street 1:3119 WOODMAN DR
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:WI
Practice Address - Zip Code:54720-2668
Practice Address - Country:US
Practice Address - Phone:920-496-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1234567207Y00000X
SC36777207Y00000X
WI61285207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology