Provider Demographics
NPI:1659605202
Name:TUSTIN, ALLEN WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:WAYNE
Last Name:TUSTIN
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 1:5342 SHARPS POINT RD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-9600
Mailing Address - Country:US
Mailing Address - Phone:410-546-4869
Mailing Address - Fax:
Practice Address - Street 1:5342 SHARPS POINT RD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-9600
Practice Address - Country:US
Practice Address - Phone:410-546-4869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD22996207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine