Healthcare Provider Details

I. General information

NPI: 1437153012
Provider Name (Legal Business Name): ALLAN R MAYER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 03/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 ASYLUM AVE STE 2110
HARTFORD CT
06105-1719
US

IV. Provider business mailing address

1000 ASYLUM AVE STE 2110
HARTFORD CT
06105-1719
US

V. Phone/Fax

Practice location:
  • Phone: 860-714-7945
  • Fax: 860-714-8880
Mailing address:
  • Phone: 860-714-7945
  • Fax: 860-714-8880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number000250
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: