Basic Information
| Provider Information | |||||||||
| NPI: | 1689652711 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALTMAN | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | PHILLIPS | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 322 E MAIN ST STE 1B | ||||||||
| Address2: | |||||||||
| City: | BRANFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064053136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2034887228 | ||||||||
| FaxNumber: | 2034887227 | ||||||||
| Practice Location | |||||||||
| Address1: | 2200 WHITNEY AVE STE 170 | ||||||||
| Address2: | |||||||||
| City: | HAMDEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065183694 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2034082700 | ||||||||
| FaxNumber: | 2038848201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2006 | ||||||||
| LastUpdateDate: | 10/08/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0106X | 38149 | CT | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery | 207X00000X | 038149 | CT | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1689652711 | 05 | CT | MEDICAID |