Provider Demographics
NPI:1104846054
Name:ALLEN, ANTHONY E (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:E
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 1:2512 TELEGRAPH AVE
Mailing Address - Street 2:STE 350
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-2918
Mailing Address - Country:US
Mailing Address - Phone:415-420-4325
Mailing Address - Fax:
Practice Address - Street 1:2512 TELEGRAPH AVE
Practice Address - Street 2:STE 350
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2918
Practice Address - Country:US
Practice Address - Phone:415-420-4325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73148207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A731483Medicare PIN