Provider Demographics
NPI:1346411881
Name:HARVEY ALLEN SR. MD
Entity Type:Organization
Organization Name:HARVEY ALLEN SR. MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN SR.
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-659-9440
Mailing Address - Street 1:491 N CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-4334
Mailing Address - Country:US
Mailing Address - Phone:336-659-9440
Mailing Address - Fax:336-659-9845
Practice Address - Street 1:491 N CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-4334
Practice Address - Country:US
Practice Address - Phone:336-659-9440
Practice Address - Fax:336-659-9845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14550207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC10835OtherBCBS
NC8910835Medicaid
NC8910835Medicaid
NC10835OtherBCBS