Provider Demographics
NPI:1285791061
Name:ALTMANN, GEORGE DAVID (CRNA)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:DAVID
Last Name:ALTMANN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:MR
Other - First Name:GEORGE
Other - Middle Name:DAVID
Other - Last Name:ALTMANN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 37090
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3090
Mailing Address - Country:US
Mailing Address - Phone:757-660-5507
Mailing Address - Fax:
Practice Address - Street 1:576 JEFFERSON AVE
Practice Address - Street 2:500 J CLYDE MORRIS BLVD NEWPORT NEWS, VA 23601
Practice Address - City:FORT EUSTIS
Practice Address - State:VA
Practice Address - Zip Code:23604-1373
Practice Address - Country:US
Practice Address - Phone:757-314-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001205086367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered