Basic Information
| Provider Information | |||||||||
| NPI: | 1134353121 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALTERMAN | ||||||||
| FirstName: | DIANE | ||||||||
| MiddleName: | LINDA | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2012 HIGHLAND AVE | ||||||||
| Address2: | |||||||||
| City: | MANHATTAN BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902664562 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105468819 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2425 N SALISBURY BLVD | ||||||||
| Address2: | |||||||||
| City: | SALISBURY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218012138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8772224934 | ||||||||
| FaxNumber: | 4103346352 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2009 | ||||||||
| LastUpdateDate: | 06/14/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | C0002136 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | PDO11856 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.