Provider Demographics
NPI:1093241739
Name:ALLEN, SAMUEL JONATHON (MBBS)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:JONATHON
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 ETHAN ALLEN AVE
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-5429
Mailing Address - Country:US
Mailing Address - Phone:301-755-8774
Mailing Address - Fax:
Practice Address - Street 1:7015 SYCAMORE AVE
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-4601
Practice Address - Country:US
Practice Address - Phone:301-755-8774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-01
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD2000012912084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry