Provider Demographics
NPI:1568084960
Name:ALLEN, ANDREW DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:DANIEL
Last Name:ALLEN
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 1:1036 FLAGLER ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-8377
Mailing Address - Country:US
Mailing Address - Phone:919-995-2725
Mailing Address - Fax:
Practice Address - Street 1:130 MASON FARM ROAD
Practice Address - Street 2:3159C BIOINFORMATICS BUILDING
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-6134
Practice Address - Country:US
Practice Address - Phone:919-966-9071
Practice Address - Fax:919-966-7956
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-08
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261792390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program