Healthcare Provider Details

I. General information

NPI: 1598312076
Provider Name (Legal Business Name): JUSTIN ALLEN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2019
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 RAWLINS DR
SEAFORD DE
19973-5881
US

IV. Provider business mailing address

PO BOX 824327
PHILADELPHIA PA
19182-4327
US

V. Phone/Fax

Practice location:
  • Phone: 302-990-3280
  • Fax: 302-990-3290
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC5-0001338
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: