Provider Demographics
NPI:1598397374
Name:ALLEN, CECIL LINWOOD
Entity Type:Individual
Prefix:
First Name:CECIL
Middle Name:LINWOOD
Last Name:ALLEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9430 CHARLES CITY VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE FORGE
Mailing Address - State:VA
Mailing Address - Zip Code:23140-2833
Mailing Address - Country:US
Mailing Address - Phone:908-294-8080
Mailing Address - Fax:
Practice Address - Street 1:9430 CHARLES CITY VILLAGE DR
Practice Address - Street 2:
Practice Address - City:PROVIDENCE FORGE
Practice Address - State:VA
Practice Address - Zip Code:23140-2833
Practice Address - Country:US
Practice Address - Phone:908-294-8080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAA62904660172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver