Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 0101057844 | VA |
Y | 2080P0202X | Pediatric Cardiologist | 0101057844 | VA |
NPI | 1235232661 |
---|---|
Provider Name | Douglas R Allen |
First Address | Charlottesville, VA 22906-9007 |
Second Address | Richmond, VA 23226-1928 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2006 |
Last Update Date | 19/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6721541 | (05) | VA |
H47370 | (02) |