MEDICARE: SAMUEL S. ALLEN

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	101YP2500X	Professional Counselor	2904	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2342249	OTHER	NC	GROUP MEDICARE

General Provider Information

NPI Number	:	1548203698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL S. ALLEN

Provider Business Mailing Address
First Line	:	PO BOX 3381
Second Line	:
City	:	ROXBORO
State	:	NC
Zip	:	27573-3381
Country	:	US
Telephone Number	:	919-313-0260
Fax Number	:

Provider Business Practice Location Address
First Line	:	2609 N DUKE ST
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27704-3019
Country	:	US
Telephone Number	:	919-313-0260
Fax Number	:	919-313-0299

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

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	07/08/2007

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Directions to “ SAMUEL S. ALLEN ” Practice Location

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