Provider Demographics
NPI:1164440772
Name:ALLEN, CAROL BEVERLY (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:BEVERLY
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 BEECHWOOD RD
Mailing Address - Street 2:
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-1623
Mailing Address - Country:US
Mailing Address - Phone:914-288-0041
Mailing Address - Fax:914-288-0041
Practice Address - Street 1:19 BEECHWOOD RD
Practice Address - Street 2:
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-1623
Practice Address - Country:US
Practice Address - Phone:914-288-0041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY145673207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03395791Medicaid
NYA400080474Medicare PIN
NYC09157Medicare UPIN