Provider Demographics
NPI:1396724100
Name:ALTOBELLI, JOHN A (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:ALTOBELLI
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 1:1230 S CEDAR CREST BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103
Mailing Address - Country:US
Mailing Address - Phone:610-434-1269
Mailing Address - Fax:
Practice Address - Street 1:1230 S CEDAR CREST BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103
Practice Address - Country:US
Practice Address - Phone:610-434-1269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD010333E2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4494535OtherAETNA
PA820985OtherFIRST PRIORITY HEALTH
PA9794516OtherCIGNA
PA384481OtherHEALTH ASSURANCE
PA50010623OtherKEYSTONE CENTRAL
CTP3159307OtherOXFORD
PA10236OtherGEISINGER
PA384481OtherHEALTH AMERICA
PA0040141000OtherKEYSTONE HEALTH PLAN EAST
PA018511OtherHIGHMARK BLUE SHIELD
PA50010623OtherCAPITAL BLUE CROSS
PA0040141000OtherPERSONAL CHOICE
PA384481OtherHEALTH ASSURANCE
PA50010623OtherKEYSTONE CENTRAL
PAP00207485Medicare ID - Type UnspecifiedRAILROAD MEDICARE