Provider Demographics
NPI:1134436645
Name:ALTIERI, MARIA SPASSOVA (MD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:SPASSOVA
Last Name:ALTIERI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3400 CIVIC CENTER BLVD FL 4
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5127
Mailing Address - Country:US
Mailing Address - Phone:215-662-2626
Mailing Address - Fax:215-614-0244
Practice Address - Street 1:3400 CIVIC CENTER BLVD FL 4
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-5127
Practice Address - Country:US
Practice Address - Phone:215-662-2626
Practice Address - Fax:215-614-0244
Is Sole Proprietor?:No
Enumeration Date:2010-09-03
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD477387208600000X
NC2019-02423208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1134436645Medicaid
NC2070MOtherBCBS OF NC
NC1134436645Medicaid