Provider Demographics
NPI:1871791087
Name:ALTMAN, JEREMIAH J (PA-C)
Entity type:Individual
Prefix:MR
First Name:JEREMIAH
Middle Name:J
Last Name:ALTMAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2614 MEMORIAL BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:CONNELLSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15425-1405
Mailing Address - Country:US
Mailing Address - Phone:724-603-3560
Mailing Address - Fax:724-603-3561
Practice Address - Street 1:2614 MEMORIAL BLVD STE A
Practice Address - Street 2:
Practice Address - City:CONNELLSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15425-1405
Practice Address - Country:US
Practice Address - Phone:724-603-3560
Practice Address - Fax:724-603-3561
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC03547363A00000X, 363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS567Q919Medicare PIN