Provider Demographics
NPI:1841410313
Name:ALLEN, BRIAN C (MSTOM)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:C
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MSTOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 CASIMIR DR
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-4521
Mailing Address - Country:US
Mailing Address - Phone:302-792-2831
Mailing Address - Fax:302-792-2831
Practice Address - Street 1:1201 PHILADELPHIA PIKE STE D
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19809-2043
Practice Address - Country:US
Practice Address - Phone:302-792-2831
Practice Address - Fax:302-792-2831
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist