Provider Demographics
NPI:1578521621
Name:MATURI ALLEN, MARY FRANCES (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:FRANCES
Last Name:MATURI ALLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:FRANCES
Other - Last Name:MATURI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 7068
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707
Mailing Address - Country:US
Mailing Address - Phone:757-686-3508
Mailing Address - Fax:757-686-0541
Practice Address - Street 1:1708 OLD DONATION PKWY
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3064
Practice Address - Country:US
Practice Address - Phone:757-395-5300
Practice Address - Fax:757-213-9341
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101041134207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC150TJOtherBCBS
VA10035022OtherOPTIMA/SENTARA
VA1578521621OtherANTHEM BCBS
VA1578521621OtherTRICARE
NC5909386Medicaid
VA2181285OtherMAMSI/UNITED HEALTHCARE
VA1578521621Medicaid
VA1448629OtherCIGNA
VA1578521621OtherTRICARE
VA1448629OtherCIGNA