Provider Demographics
NPI:1184692212
Name:ALTMAN, LEE S (MD)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:S
Last Name:ALTMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1044 CENTRAL ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-4423
Mailing Address - Country:US
Mailing Address - Phone:781-436-8390
Mailing Address - Fax:781-436-8392
Practice Address - Street 1:1044 CENTRAL ST
Practice Address - Street 2:SUITE 103
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-4423
Practice Address - Country:US
Practice Address - Phone:781-436-8390
Practice Address - Fax:781-436-8392
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2017-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA806962084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAA30070Medicare PIN