Provider Demographics
NPI:1417970492
Name:ALLEN, ELAINE (DPM)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 FOUR LEAF LN STE 11A
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-9203
Mailing Address - Country:US
Mailing Address - Phone:434-242-8550
Mailing Address - Fax:434-205-4637
Practice Address - Street 1:325 FOUR LEAF LN STE 11A
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-9203
Practice Address - Country:US
Practice Address - Phone:434-242-8550
Practice Address - Fax:434-205-4637
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000744213E00000X, 213ER0200X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3641408OtherAETNA HMO
GA393136OtherBLUE CROSS BLUE SHEILD
GA5217840001OtherDMERC - PALMETTO
4572029OtherAETNA PPO/POS
GA00698167DMedicaid
GA323715OtherWELLCARE OF GEORGIA
0000163909413OtherUNITED HEALTHCARE
P00240565OtherRAILROAD MEDICARE
GA323715OtherWELLCARE OF GEORGIA
4572029OtherAETNA PPO/POS