Provider Demographics
NPI:1790741353
Name:ALTMAN, KRISTIINA SLR (MD)
Entity Type:Individual
Prefix:
First Name:KRISTIINA
Middle Name:SLR
Last Name:ALTMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTIINA
Other - Middle Name:SINI
Other - Last Name:RUUTIAINEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 64313
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4313
Mailing Address - Country:US
Mailing Address - Phone:410-550-0335
Mailing Address - Fax:
Practice Address - Street 1:4940 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-2735
Practice Address - Country:US
Practice Address - Phone:410-550-7802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD54975207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD407702400Medicaid
MD407702400Medicaid
MDH774A882Medicare PIN