Provider Demographics
NPI:1336332105
Name:ALTER-KING, ANITA (PT)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:ALTER-KING
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CHARTLEY DR
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-2328
Mailing Address - Country:US
Mailing Address - Phone:410-833-5300
Mailing Address - Fax:
Practice Address - Street 1:2 CHARTLEY DR
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-2328
Practice Address - Country:US
Practice Address - Phone:410-833-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17313174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDJ247OtherBC/BS
MDS285OtherBC/BS
MDJ247OtherBC/BS