Provider Demographics
NPI:1881892529
Name:ALLEN, BRIAN MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:MICHAEL
Last Name:ALLEN
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 1:399 FARMINGTON AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1936
Mailing Address - Country:US
Mailing Address - Phone:860-548-7338
Mailing Address - Fax:860-674-4232
Practice Address - Street 1:399 FARMINGTON AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1936
Practice Address - Country:US
Practice Address - Phone:860-548-7338
Practice Address - Fax:860-674-4232
Is Sole Proprietor?:No
Enumeration Date:2007-07-04
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA65381208200000X
CT0528132086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1881892529OtherANTHEM BCBS
GA202I022436OtherMEDICARE PTAN