Provider Demographics
NPI:1326068156
Name:ALLEN, JANICE GRACIA (MD)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:GRACIA
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 S MOUNT VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-3223
Mailing Address - Country:US
Mailing Address - Phone:724-437-9858
Mailing Address - Fax:724-438-2890
Practice Address - Street 1:1 S MOUNT VERNON AVE
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-3223
Practice Address - Country:US
Practice Address - Phone:724-437-9858
Practice Address - Fax:724-438-2890
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019358E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC90078Medicare UPIN