Provider Demographics
NPI:1609005958
Name:GREGORY G ALLEN JR, D.O. INC
Entity Type:Organization
Organization Name:GREGORY G ALLEN JR, D.O. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:BERGERON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-946-6460
Mailing Address - Street 1:1681 CRANSTON ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-5000
Mailing Address - Country:US
Mailing Address - Phone:401-946-8446
Mailing Address - Fax:401-946-8340
Practice Address - Street 1:1681 CRANSTON ST
Practice Address - Street 2:SUITE D
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-5000
Practice Address - Country:US
Practice Address - Phone:401-946-8446
Practice Address - Fax:401-946-8340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDO 00582207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RII 30960Medicare UPIN