Provider Demographics
NPI:1730263617
Name:ALTER, MARK DAVID (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:DAVID
Last Name:ALTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:765 E ROUTE 70
Mailing Address - Street 2:BUILDING A
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-2341
Mailing Address - Country:US
Mailing Address - Phone:856-552-4347
Mailing Address - Fax:856-797-4785
Practice Address - Street 1:2160 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-3328
Practice Address - Country:US
Practice Address - Phone:708-216-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD4349112084P0800X
VA01012595762084P0800X
NJ25MA087755002084P0800X
CAC1612922084P0800X
WI17452084P0800X
IL0361392172084P0800X, 2084P0804X
MTMED-PHYS-LIC-486912084P0800X
DEC1-00104132084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0331082Medicaid