Basic Information
| Provider Information | |||||||||
| NPI: | 1669415402 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALTEN | ||||||||
| FirstName: | BEVERLY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3035 HAMILTON MASON RD STE 201 | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD TOWNSHIP | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450115545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138944121 | ||||||||
| FaxNumber: | 5138944120 | ||||||||
| Practice Location | |||||||||
| Address1: | 3035 HAMILTON MASON RD STE 201 | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD TOWNSHIP | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138944121 | ||||||||
| FaxNumber: | 5138944120 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2006 | ||||||||
| LastUpdateDate: | 11/17/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 2001009168 | MO | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | OOO26669 | AL | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 35.134793 | OH | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 0312200 | 05 | OH | MEDICAID |