Provider Demographics
NPI:1225083843
Name:ALLEN, JANE (MD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:JANE
Other - Middle Name:
Other - Last Name:DIESNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8110 MAPLE LAWN BLVD STE 235
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-2694
Mailing Address - Country:US
Mailing Address - Phone:301-340-8339
Mailing Address - Fax:301-340-9027
Practice Address - Street 1:161 FORT EVANS RD NE
Practice Address - Street 2:SUITE 320
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-3369
Practice Address - Country:US
Practice Address - Phone:703-777-5111
Practice Address - Fax:703-777-8465
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101231761207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006217052Medicaid
VA006217052Medicaid
H77486Medicare UPIN