Provider Demographics
NPI:1205886181
Name:ALLERTON, JEFFREY PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:PAUL
Last Name:ALLERTON
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 1:1 ATWELL RD
Mailing Address - Street 2:
Mailing Address - City:COOPERSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13326-1301
Mailing Address - Country:US
Mailing Address - Phone:607-547-3336
Mailing Address - Fax:607-547-3891
Practice Address - Street 1:1 ATWELL RD
Practice Address - Street 2:
Practice Address - City:COOPERSTOWN
Practice Address - State:NY
Practice Address - Zip Code:13326-1301
Practice Address - Country:US
Practice Address - Phone:607-547-3336
Practice Address - Fax:607-547-3891
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239959207RH0003X, 207RH0002X, 207RH0003X
IN01072996A207RH0003X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201174520Medicaid
IN090540079Medicare PIN
A66533Medicare UPIN
PAGU039841OtherMEDICARE GROUP
PACC9269OtherRR MEDICARE GROUP
A66533Medicare UPIN
NY02770767Medicaid
PA101729N82Medicare PIN
PA1016153530001Medicaid
IN567230010Medicare PIN
PAP00313160OtherRR MEDICARE PIN
NYJ400001147Medicare PIN