MEDICARE: DR. SHANNEN K. ALLEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	D0064522	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407876360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANNEN K. ALLEN MD

Provider Business Mailing Address
First Line	:	15005 SHADY GROVE RD.
Second Line	:	SUITE 100
City	:	ROCKVILLE
State	:	MD
Zip	:	20850-6341
Country	:	US
Telephone Number	:	301-279-9696
Fax Number	:	301-251-5454

Provider Business Practice Location Address
First Line	:	15005 SHADY GROVE RD.
Second Line	:	STE 100
City	:	ROCKVILLE
State	:	MD
Zip	:	20850-6341
Country	:	US
Telephone Number	:	301-279-9696
Fax Number	:	301-251-5454

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	07/07/2011

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