Provider Demographics
NPI:1457670002
Name:ALLAN, AMARIS H (MD)
Entity Type:Individual
Prefix:
First Name:AMARIS
Middle Name:H
Last Name:ALLAN
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 1:120 S TAN ALY STE 1
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17026-9349
Mailing Address - Country:US
Mailing Address - Phone:717-865-6644
Mailing Address - Fax:717-865-5666
Practice Address - Street 1:3156 KENSINGTON AVE STE 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-2400
Practice Address - Country:US
Practice Address - Phone:215-831-1100
Practice Address - Fax:215-807-8951
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-21
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT196943390200000X
PAMD447774207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program