Basic Information
Provider Information
NPI: 1558778993
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALLEN
FirstName: ANNE VALERIE
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 111 S FRONT ST
Address2:  
City: HARRISBURG
State: PA
PostalCode: 171012010
CountryCode: US
TelephoneNumber: 7172318772
FaxNumber:  
Practice Location
Address1: 4300 LONDONDERRY RD
Address2:  
City: HARRISBURG
State: PA
PostalCode: 171095317
CountryCode: US
TelephoneNumber: 7172318771
FaxNumber: 7172318435
Other Information
ProviderEnumerationDate: 07/17/2014
LastUpdateDate: 07/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/16/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
207R00000XMD461937PAY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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