Provider Demographics
NPI:1043217250
Name:ALLEN, GREGORY G (DO)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:G
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1681 CRANSTON ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-5000
Mailing Address - Country:US
Mailing Address - Phone:401-946-8446
Mailing Address - Fax:401-946-8340
Practice Address - Street 1:1681 CRANSTON ST
Practice Address - Street 2:SUITE D
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-5000
Practice Address - Country:US
Practice Address - Phone:401-946-8446
Practice Address - Fax:401-946-8340
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDO 00582207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI119003084Medicare ID - Type Unspecified
RII 30960Medicare UPIN