Provider Demographics
NPI:1285633198
Name:ALLEN, MARK HAROLD (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:HAROLD
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:329 CONWAY ST
Mailing Address - Street 2:GREENFIELD HEALTH CENTER
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-1526
Mailing Address - Country:US
Mailing Address - Phone:413-774-6301
Mailing Address - Fax:413-774-6528
Practice Address - Street 1:329 CONWAY ST
Practice Address - Street 2:GREENFIELD HEALTH CENTER
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-1526
Practice Address - Country:US
Practice Address - Phone:413-774-6301
Practice Address - Fax:413-774-6528
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA37955207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2031523Medicaid
MAF10075OtherBLUE CROSS& BLUE SHIELD
MAF10075OtherBLUE CROSS& BLUE SHIELD
MA2031523Medicaid