Provider Demographics
NPI:1225251796
Name:BRIAN D ALLEN MD PLLC
Entity Type:Organization
Organization Name:BRIAN D ALLEN MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-982-1399
Mailing Address - Street 1:923 NORTH SECOND ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-3370
Mailing Address - Country:US
Mailing Address - Phone:704-982-1399
Mailing Address - Fax:704-982-1510
Practice Address - Street 1:923 NORTH SECOND STREET
Practice Address - Street 2:SUITE 205
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-3370
Practice Address - Country:US
Practice Address - Phone:704-982-1399
Practice Address - Fax:704-982-1510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600324208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8910678Medicaid
NC10678OtherBCBS
NC8910678Medicaid