Provider Demographics
NPI:1619901030
Name:ALLEN, JOANNE B (MD)
Entity Type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:B
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1568
Mailing Address - Street 2:
Mailing Address - City:WRIGHTSVILLE BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28480-1568
Mailing Address - Country:US
Mailing Address - Phone:910-515-1506
Mailing Address - Fax:910-817-6775
Practice Address - Street 1:1721 ALLENS LN STE 101
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-3662
Practice Address - Country:US
Practice Address - Phone:910-515-1506
Practice Address - Fax:910-817-6775
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200100008208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5900869Medicaid
NCL31664Medicare UPIN
NC225919Medicare PIN
NC2040639Medicare ID - Type Unspecified