Provider Demographics
NPI:1952516544
Name:ALLEN, JOSEPH P (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:P
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 1:810 FALLS CREEK DR
Mailing Address - Street 2:STE B
Mailing Address - City:VANDALIA
Mailing Address - State:OH
Mailing Address - Zip Code:45377-8600
Mailing Address - Country:US
Mailing Address - Phone:937-454-0317
Mailing Address - Fax:
Practice Address - Street 1:1 W NATIONAL RD
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377
Practice Address - Country:US
Practice Address - Phone:937-208-7776
Practice Address - Fax:937-208-7751
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.092416207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2980823Medicaid
OH4267382Medicare PIN
OH2980823Medicaid