Provider Demographics
NPI:1679592067
Name:ALLEN, MARTHA J (PA)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:J
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03756-1000
Mailing Address - Country:US
Mailing Address - Phone:603-650-4000
Mailing Address - Fax:
Practice Address - Street 1:DARTMOUTH HITCHCOCK MEDICAL CENTER
Practice Address - Street 2:1 MEDICAL CENTER DR
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756
Practice Address - Country:US
Practice Address - Phone:603-650-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0540363A00000X
VT055-0030581363A00000X
VT055-0030427363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30333545Medicaid
NHAP2389Medicare ID - Type Unspecified
NH30333545Medicaid