1790768182 NPI number — DR. MARK ERICH ALLEN D.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790768182 NPI number — DR. MARK ERICH ALLEN D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALLEN
Provider First Name:
MARK
Provider Middle Name:
ERICH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
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:
1790768182
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/12/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
894 BROADWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH PORTLAND
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04106-4350
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-699-2226
Provider Business Mailing Address Fax Number:
207-699-2229

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
894 BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH PORTLAND
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04106-4350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-699-2226
Provider Business Practice Location Address Fax Number:
207-699-2229
Provider Enumeration Date:
11/21/2005

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: 111N00000X , with the licence number:  CR1365 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: M204600 . This is a "CIGNA" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 352582 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 522405696 . This is a "MED NET SYSTEMS" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 177050000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 522405696 . This is a "HEALTH PLANS INC" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 640621 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 2193260 . This is a "FIRST HEALTH CARE SYSTEMS" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 4639291 . This is a "AETNA" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 522405696 . This is a "PRIVATE HEALTHCARE SYSTEM" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 522405696 . This is a "PREFERREDONE ADMIN SERVIC" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 022415 . This is a "ANTHEM" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




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