Provider Demographics
NPI:1033188487
Name:ALLEN, HERBERT RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:RICHARD
Last Name:ALLEN
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:PO BOX 18563
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27619-8563
Mailing Address - Country:US
Mailing Address - Phone:434-447-2300
Mailing Address - Fax:434-447-2377
Practice Address - Street 1:500 N THOMAS ST
Practice Address - Street 2:
Practice Address - City:SOUTH HILL
Practice Address - State:VA
Practice Address - Zip Code:23970-1421
Practice Address - Country:US
Practice Address - Phone:434-447-2300
Practice Address - Fax:434-447-2377
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30535207RG0100X
VA0101039630174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005828449Medicaid
VA100000246Medicare ID - Type UnspecifiedMEDICARE
VA005828449Medicaid