Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 4 | MD |
Y | 213ES0000X | Sports Medicine | 4 | MD |
NPI | 1497220271 |
---|---|
Provider Name | Thomas Andrew Allen |
First Address | Damascus, MD 20872-2201 |
Second Address | Damascus, MD 20872-2201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2018 |
Last Update Date | 09/10/2018 |