Provider Demographics
NPI:1932274925
Name:ALLEN, TERRY A (MD)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:A
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 1:10721 MAIN ST
Mailing Address - Street 2:# 200
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030
Mailing Address - Country:US
Mailing Address - Phone:703-385-6870
Mailing Address - Fax:703-385-6875
Practice Address - Street 1:10721 MAIN ST
Practice Address - Street 2:# 200
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030
Practice Address - Country:US
Practice Address - Phone:703-385-6875
Practice Address - Fax:703-385-6875
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101226190207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3574058OtherHMO
138982OtherANTHEM BCBS
8996869OtherCIGNA
503341OtherNCPPO
2125648OtherMAMSI
2187314OtherUNITED HEALTHCARE
J758000OtherCAREFIRST BCBS
7059140OtherAETNA
BA6755043OtherDEA
503341OtherNCPPO