Provider Demographics
NPI:1235108853
Name:SLOAN, ALLEN L (MD)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:L
Last Name:SLOAN
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 1:1168 W MARTINTOWN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-2046
Mailing Address - Country:US
Mailing Address - Phone:803-202-0053
Mailing Address - Fax:803-202-0018
Practice Address - Street 1:1168 W MARTINTOWN RD
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-2046
Practice Address - Country:US
Practice Address - Phone:803-202-0053
Practice Address - Fax:803-202-0018
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14285207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC142851Medicaid
GA00378672DMedicaid
SC142851Medicaid
GA00378672DMedicaid