Provider Demographics
NPI:1033199831
Name:ALLEN, MARTIN AUGUSTUS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:AUGUSTUS
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 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:10110 CLEMSON BLVD
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-0812
Practice Address - Country:US
Practice Address - Phone:864-482-3148
Practice Address - Fax:864-482-0505
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36847207V00000X
NC36640207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0701372OtherUNITED HEALTHCARE
NC10901OtherBCBSNC
NC4120OtherPARTNERS
SC368471Medicaid
NC8910901Medicaid
SC8768Medicare UPIN
NC2186434BMedicare PIN
NC4120OtherPARTNERS
NC0701372OtherUNITED HEALTHCARE
SCGP4697Medicaid