Provider Demographics
NPI:1134186745
Name:WESTERFIELD, ALLEN DAVID IV (MD)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:DAVID
Last Name:WESTERFIELD
Suffix:IV
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 1:1218 S BROADWAY
Mailing Address - Street 2:SUITE 310
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2759
Mailing Address - Country:US
Mailing Address - Phone:859-219-0542
Mailing Address - Fax:859-219-9433
Practice Address - Street 1:1218 S BROADWAY
Practice Address - Street 2:SUITE 310
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-2759
Practice Address - Country:US
Practice Address - Phone:859-219-0542
Practice Address - Fax:859-219-9433
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY347282085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64001449Medicaid
0572112Medicare PIN
KY64001449Medicaid
H06415Medicare UPIN
0581312Medicare ID - Type Unspecified
0946411Medicare ID - Type Unspecified
0572112Medicare PIN
0571912Medicare ID - Type Unspecified
KY64001449Medicaid
0572012Medicare ID - Type Unspecified
0581212Medicare ID - Type Unspecified
0765710Medicare ID - Type Unspecified
0674601Medicare ID - Type Unspecified
0991709Medicare ID - Type Unspecified