Provider Demographics
NPI:1356551071
Name:ALTAMIRANO, ALEX B (MD)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:B
Last Name:ALTAMIRANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:197 LINDEN ST
Mailing Address - Street 2:APT 1E
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-3287
Mailing Address - Country:US
Mailing Address - Phone:646-247-6604
Mailing Address - Fax:
Practice Address - Street 1:235 MAPLE ST
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-5123
Practice Address - Country:US
Practice Address - Phone:413-532-0389
Practice Address - Fax:413-532-1548
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2314752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry