Provider Demographics
NPI:1659450484
Name:DOCTOR, ALLAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:
Last Name:DOCTOR
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 1:670 W BALTIMORE ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1519
Mailing Address - Country:US
Mailing Address - Phone:410-706-7088
Mailing Address - Fax:410-706-4141
Practice Address - Street 1:22 S GREENE ST STE G4K400
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-6957
Practice Address - Fax:410-328-0680
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006031510207LP3000X, 208000000X, 2080P0203X
MDD883262080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO204914402Medicaid
MD502384000Medicaid
ILENROLLEDMedicaid