Provider Demographics
NPI:1689968216
Name:ALLEN, JOHN BRADLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BRADLEY
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6035 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3256
Mailing Address - Country:US
Mailing Address - Phone:704-295-3000
Mailing Address - Fax:704-295-3448
Practice Address - Street 1:13532 STEELECROFT PKWY
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28278-7545
Practice Address - Country:US
Practice Address - Phone:704-295-3475
Practice Address - Fax:704-295-3476
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2017-00467207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNC3146Medicaid
OH0122221Medicaid
OHH332890Medicare PIN