Basic Information
| Provider Information | |||||||||
| NPI: | 1568084960 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALLEN | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | DANIEL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1036 FLAGLER ST | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277138377 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199952725 | ||||||||
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| Practice Location | |||||||||
| Address1: | 130 MASON FARM ROAD | ||||||||
| Address2: | 3159C BIOINFORMATICS BUILDING | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275996134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199669071 | ||||||||
| FaxNumber: | 9199667956 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2020 | ||||||||
| LastUpdateDate: | 05/13/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 261792 | NC | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.