Provider Demographics
NPI:1407911712
Name:ALLEN, TERESA E (MD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:E
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 1:2101 E JEFFERSON ST
Mailing Address - Street 2:KAISER PERMANENTE MEDICARE ENROLLMENT
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-2424
Mailing Address - Fax:
Practice Address - Street 1:6525 BELCREST ROAD
Practice Address - Street 2:SUITE 160
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-3091
Practice Address - Country:US
Practice Address - Phone:301-209-6250
Practice Address - Fax:301-209-6204
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0034795207R00000X
VA0101042186207R00000X
DCMD15686207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
C87905Medicare UPIN
143843M92Medicare ID - Type Unspecified