Basic Information
| Provider Information | |||||||||
| NPI: | 1346411881 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HARVEY ALLEN SR. MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 491 N CLEVELAND AVE | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271014334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366599440 | ||||||||
| FaxNumber: | 3366599845 | ||||||||
| Practice Location | |||||||||
| Address1: | 491 N CLEVELAND AVE | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271014334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366599440 | ||||||||
| FaxNumber: | 3366599845 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2008 | ||||||||
| LastUpdateDate: | 03/12/2008 | ||||||||
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| AuthorizedOfficialLastName: | ALLEN SR. | ||||||||
| AuthorizedOfficialFirstName: | HARVEY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3366599440 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 14550 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 10835 | 01 | NC | BCBS | OTHER | 8910835 | 05 | NC | MEDICAID |