Provider Demographics
NPI:1689858136
Name:KATHLEEN A ALTER M.D.
Entity type:Organization
Organization Name:KATHLEEN A ALTER M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ALTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-860-2777
Mailing Address - Street 1:2960 MACK RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-5373
Mailing Address - Country:US
Mailing Address - Phone:513-860-2777
Mailing Address - Fax:513-860-9507
Practice Address - Street 1:2960 MACK RD
Practice Address - Street 2:SUITE 210
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5373
Practice Address - Country:US
Practice Address - Phone:513-860-2777
Practice Address - Fax:513-860-9507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50765207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0631427Medicaid
OH9331251Medicare PIN
OHE33485Medicare UPIN