Provider Demographics
NPI:1770554438
Name:ALTMAN, JEREMY (MD)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:
Last Name:ALTMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-812-4083
Mailing Address - Fax:717-812-2244
Practice Address - Street 1:35 MONUMENT RD
Practice Address - Street 2:SUITE 201
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-5074
Practice Address - Country:US
Practice Address - Phone:717-812-4083
Practice Address - Fax:717-812-2244
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00158672085N0700X, 2085R0202X, 2085R0204X
PAMD4330332085N0700X, 2085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD154361001Medicaid
MD939710OtherCAREFIRST MD BCBS
PA019002OtherJOHNS HOPKINS
MDJ062OtherB/C B/S
PA019766OtherHIGHMARK BLUE SHIELD
PA102229262Medicaid
PA20082066OtherAMERIHEALTH MERCY-WMG
PA50082028OtherCAPITAL BLUE CROSS-WMG
MDKA80OtherB/C B/S
PA116155OtherGEISINGER HEALTH PLAN
PA259543OtherUNISON-WMG
DC2849OtherB/C B/S
PA1578482OtherGATEWAY-WMG
PA102229262Medicaid
PA116155OtherGEISINGER HEALTH PLAN
PA019766OtherHIGHMARK BLUE SHIELD
MD154361001Medicaid
MDKA80OtherB/C B/S
PA019002OtherJOHNS HOPKINS
MDJ062OtherB/C B/S
PA1578482OtherGATEWAY-WMG
DE00B662A20Medicare ID - Type UnspecifiedLOCALITY/JURIS. 02 DC/DE
MDCN2566Medicare ID - Type UnspecifiedRAILROAD MEDICARE