Provider Demographics
NPI:1265464655
Name:MARK T ALLEN, M.D.
Entity Type:Organization
Organization Name:MARK T ALLEN, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SERVICE
Authorized Official - Prefix:MS
Authorized Official - First Name:DOLORES
Authorized Official - Middle Name:D
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-659-5204
Mailing Address - Street 1:PO BOX 3220
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-0220
Mailing Address - Country:US
Mailing Address - Phone:215-787-9344
Mailing Address - Fax:
Practice Address - Street 1:1600 WEST GIRARD AVENUE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130
Practice Address - Country:US
Practice Address - Phone:215-787-9344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038491L207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC34478Medicare UPIN
PA038756Medicare UPIN