1548253834 NPI number — MARK D ALLEN MD

Table of content: MARK D ALLEN MD (NPI 1548253834)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548253834 NPI number — MARK D ALLEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALLEN
Provider First Name:
MARK
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548253834
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
318 N LANSDOWNE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANSDOWNE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19050-1018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-259-8344
Provider Business Mailing Address Fax Number:
610-259-3385

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
318 N LANSDOWNE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANSDOWNE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19050-1018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-259-8344
Provider Business Practice Location Address Fax Number:
610-259-3385
Provider Enumeration Date:
08/23/2005

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: 207X00000X , with the licence number:  MD038491L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0103215202 . This is a "AMERICHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1148659 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 15010 . This is a "BRAVO ELDER HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 13361 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 995155 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 001032152 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00197203 . This is a "RR MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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