Provider Demographics
NPI:1134353121
Name:ALTERMAN, DIANE LINDA (PA-C)
Entity type:Individual
Prefix:MISS
First Name:DIANE
Middle Name:LINDA
Last Name:ALTERMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-4562
Mailing Address - Country:US
Mailing Address - Phone:310-546-8819
Mailing Address - Fax:
Practice Address - Street 1:2425 N SALISBURY BLVD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-2138
Practice Address - Country:US
Practice Address - Phone:877-222-4934
Practice Address - Fax:410-334-6352
Is Sole Proprietor?:No
Enumeration Date:2009-05-06
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002136363A00000X
CAPDO11856363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant