Provider Demographics
NPI:1972206043
Name:WELLMAN, ALLEN ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:ANDREW
Last Name:WELLMAN
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 1:549 FAIR ST # MC61-22
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-1419
Mailing Address - Country:US
Mailing Address - Phone:570-416-1925
Mailing Address - Fax:
Practice Address - Street 1:549 FAIR ST # MC61-22
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-1419
Practice Address - Country:US
Practice Address - Phone:570-416-1925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT229656390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program