Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 000744 | GA |
N | 222Z00000X | Podiatrist | 000744 | GA |
N | 111NR0200X | Radiology | 000744 | GA |
N | 213ER0200X | Radiology | 000744 | GA |
Y | 213ES0103X | Foot & Ankle Surgery | 000744 | GA |
NPI | 1417970492 |
---|---|
Provider Name | Ms. Elaine Allen |
First Address | Charlottesville, VA 22903-9203 |
Second Address | Charlottesville, VA 22903-9203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000163909413 | UNITED HEALTHCARE (01) | |
00698167D | (05) | GA |
323715 | WELLCARE OF GEORGIA (01) | GA |
3641408 | AETNA HMO (01) | |
393136 | BLUE CROSS BLUE SHEILD (01) | GA |
4572029 | AETNA PPO/POS (01) | |
5217840001 | DMERC - PALMETTO (01) | GA |
P00240565 | RAILROAD MEDICARE (01) | |
U57157 | (02) | GA |