Provider Demographics
NPI:1841287539
Name:ALTAMURO, CHRISTOPHER (DO)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:ALTAMURO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:GLASSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08028-2718
Mailing Address - Country:US
Mailing Address - Phone:856-863-9928
Mailing Address - Fax:
Practice Address - Street 1:2848 S DELSEA DR
Practice Address - Street 2:SUITE 4B
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-7042
Practice Address - Country:US
Practice Address - Phone:856-205-7070
Practice Address - Fax:856-205-0145
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB54988207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5215901Medicaid
NJ223772973OtherTAX ID
496931OtherAETNA/HMO
NJ10650756OtherCAQH
NJ4248043OtherAETNA PIN
0533428000OtherAMERIHEALTH
080179131OtherRR MEDICARE
NJF07001Medicare UPIN
496931OtherAETNA/HMO