Provider Demographics
NPI:1689979437
Name:CYRIL A ALLEN MD LLC
Entity Type:Organization
Organization Name:CYRIL A ALLEN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:CYRIL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-574-6141
Mailing Address - Street 1:8205 WATERSIDE CT
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-5571
Mailing Address - Country:US
Mailing Address - Phone:202-309-1848
Mailing Address - Fax:
Practice Address - Street 1:1328 SOUTHERN AVE SE
Practice Address - Street 2:202
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4689
Practice Address - Country:US
Practice Address - Phone:202-574-6141
Practice Address - Fax:202-373-5956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD33401207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC035321900Medicaid
DC136220OtherMEDICARE PTAN