Provider Demographics
NPI:1508903089
Name:ALLAN, WALTER CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:CHARLES
Last Name:ALLAN
Suffix:
Gender:M
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:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04070-0190
Mailing Address - Country:US
Mailing Address - Phone:207-883-4131
Mailing Address - Fax:207-885-0807
Practice Address - Street 1:8 SCIENCE PARK RD
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-7169
Practice Address - Country:US
Practice Address - Phone:207-883-4131
Practice Address - Fax:207-885-0807
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0094342084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME237370000Medicaid
NH30201168Medicaid
ME037355OtherANTHEM PIN
ME3734857003OtherCIGNA PIN
MEC66285Medicare UPIN
ME237370000Medicaid