Provider Demographics
NPI:1194928457
Name:ALTMAN, JAMES RYAN (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:RYAN
Last Name:ALTMAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2899
Mailing Address - Country:US
Mailing Address - Phone:864-522-8611
Mailing Address - Fax:
Practice Address - Street 1:100 N SUMTER ST STE 202
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4975
Practice Address - Country:US
Practice Address - Phone:803-774-9797
Practice Address - Fax:803-933-3012
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC32865207R00000X, 207RC0000X, 207RI0011X
TXBP10050791390200000X
NC141391390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC328657Medicaid
SCGP1908OtherGROUP MCAID
SCAA54995879Medicare PIN
SCAA54997153Medicare PIN
SC328657Medicaid
SCGP1908OtherGROUP MCAID
SC7153Medicare PIN
SCGP4840OtherGROUP MEDICAID