Healthcare Provider Details

I. General information

NPI: 1881892529
Provider Name (Legal Business Name): BRIAN MICHAEL ALLEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2007
Last Update Date: 06/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 FARMINGTON AVE SUITE 200
FARMINGTON CT
06032-1936
US

IV. Provider business mailing address

399 FARMINGTON AVE SUITE 200
FARMINGTON CT
06032-1936
US

V. Phone/Fax

Practice location:
  • Phone: 860-548-7338
  • Fax: 860-674-4232
Mailing address:
  • Phone: 860-548-7338
  • Fax: 860-674-4232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number65381
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number052813
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: