Provider Demographics
NPI:1770618951
Name:ALLEN, BONNIE G (MD)
Entity type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:G
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10133 BACON DR
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-2102
Mailing Address - Country:US
Mailing Address - Phone:301-937-4072
Mailing Address - Fax:
Practice Address - Street 1:10133 BACON DR
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-2102
Practice Address - Country:US
Practice Address - Phone:301-937-4072
Practice Address - Fax:301-937-2332
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010474822085R0202X
DCMD137632085R0202X
MDD388812085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C89054Medicare UPIN
006437M92Medicare ID - Type Unspecified
S883N076Medicare ID - Type Unspecified