Healthcare Provider Details

I. General information

NPI: 1285633198
Provider Name (Legal Business Name): MARK HAROLD ALLEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 CONWAY ST GREENFIELD HEALTH CENTER
GREENFIELD MA
01301-1526
US

IV. Provider business mailing address

329 CONWAY ST GREENFIELD HEALTH CENTER
GREENFIELD MA
01301-1526
US

V. Phone/Fax

Practice location:
  • Phone: 413-774-6301
  • Fax: 413-774-6528
Mailing address:
  • Phone: 413-774-6301
  • Fax: 413-774-6528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number37955
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: