Provider Demographics
NPI:1013084508
Name:ALTER, LAUREN J (MD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:J
Last Name:ALTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 843223
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-3223
Mailing Address - Country:US
Mailing Address - Phone:910-417-4005
Mailing Address - Fax:910-417-4014
Practice Address - Street 1:809 S LONG DR STE H
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-4317
Practice Address - Country:US
Practice Address - Phone:910-417-4005
Practice Address - Fax:910-417-4014
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA045598174400000X
NC2009-01875207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNC1061Medicaid
NJ544396OtherKEYSTONE
NJ1087035OtherHORIZON NJ HEALTH
NJ0297905002OtherAMERIHEALTH
NJ115500OtherAETNA
NJ223497588OtherHORIZON BCBS
NJ1212463009OtherCIGNA
NJ2343401Medicaid
NJOXFORDOtherP582673
NJ0297905002OtherAMERIHEALTH
NJ544396OtherKEYSTONE