Provider Demographics
NPI:1558365171
Name:ALLEN, DAVID P (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:P
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:200 POCAHONTAS TRAIL
Mailing Address - City:WHITE SULPHUR SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:24986-0457
Mailing Address - Country:US
Mailing Address - Phone:304-536-5030
Mailing Address - Fax:304-536-5031
Practice Address - Street 1:1102 MAIN ST
Practice Address - Street 2:STE A
Practice Address - City:RAINELLE
Practice Address - State:WV
Practice Address - Zip Code:25962-1253
Practice Address - Country:US
Practice Address - Phone:304-438-8561
Practice Address - Fax:304-438-6754
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV696207Q00000X
VA0102050099207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0049368000Medicaid
VA1558365171Medicaid
080095167Medicare ID - Type UnspecifiedRAILROAD MEDICARE/RRMC
WVAL0488144Medicare ID - Type UnspecifiedWV MEDICARE
WV0049368000Medicaid