1225083843 NPI number — DR. JANE ALLEN MD

Table of content: DR. JANE ALLEN MD (NPI 1225083843)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225083843 NPI number — DR. JANE ALLEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALLEN
Provider First Name:
JANE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DIESNER
Provider Other First Name:
JANE
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1225083843
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8110 MAPLE LAWN BLVD STE 235
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FULTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20759-2694
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-340-8339
Provider Business Mailing Address Fax Number:
301-340-9027

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
161 FORT EVANS RD NE
Provider Second Line Business Practice Location Address:
SUITE 320
Provider Business Practice Location Address City Name:
LEESBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20176-3369
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-777-5111
Provider Business Practice Location Address Fax Number:
703-777-8465
Provider Enumeration Date:
05/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  0101231761 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 006217052 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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