Provider Demographics
NPI:1134421001
Name:ALTEPETER, TARA A (MD)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:A
Last Name:ALTEPETER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 ROCKLAND ROAD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803
Mailing Address - Country:US
Mailing Address - Phone:302-651-5928
Mailing Address - Fax:302-651-5838
Practice Address - Street 1:1600 ROCKLAND RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3607
Practice Address - Country:US
Practice Address - Phone:302-651-5928
Practice Address - Fax:302-651-5838
Is Sole Proprietor?:No
Enumeration Date:2010-11-29
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.126876208000000X
DEC7-00050002080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics