Provider Demographics
NPI:1427624337
Name:ALTAMIRANO, FABIAN ANDRES (MD)
Entity type:Individual
Prefix:
First Name:FABIAN
Middle Name:ANDRES
Last Name:ALTAMIRANO
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:OFFICE OF GRADUATE MEDICAL EDUCATION
Mailing Address - Street 2:303 PARKWAY NE
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312
Mailing Address - Country:US
Mailing Address - Phone:404-265-4919
Mailing Address - Fax:404-265-4989
Practice Address - Street 1:OFFICE OF GRADUATE MEDICAL EDUCATION
Practice Address - Street 2:303 PARKWAY NE
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312
Practice Address - Country:US
Practice Address - Phone:404-265-4919
Practice Address - Fax:404-265-4989
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-01
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program