Provider Demographics
NPI:1760462147
Name:ALLARA, R. DAVID (MD)
Entity Type:Individual
Prefix:
First Name:R.
Middle Name:DAVID
Last Name:ALLARA
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 1:310 35TH ST SE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1352
Mailing Address - Country:US
Mailing Address - Phone:304-926-0955
Mailing Address - Fax:304-926-0958
Practice Address - Street 1:310 35TH ST SE
Practice Address - Street 2:SUITE 11
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1352
Practice Address - Country:US
Practice Address - Phone:304-926-0955
Practice Address - Fax:304-926-0958
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV14971207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0094930000Medicaid
WV341428OtherMAMSI
WV328002OtherTRIGON BC
WV1045779OtherBRICKSTREET
WV96770OtherCARELINK
WV0598609Medicare ID - Type Unspecified
WV1045779OtherBRICKSTREET