Healthcare Provider Details

I. General information

NPI: 1861599490
Provider Name (Legal Business Name): RHONDA LYNN ALLEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 LOCH RAVEN BLVD FL 2
BALTIMORE MD
21239-2902
US

IV. Provider business mailing address

3115 LORENZO LN
WOODBINE MD
21797-7501
US

V. Phone/Fax

Practice location:
  • Phone: 301-332-4108
  • Fax: 410-234-8093
Mailing address:
  • Phone: 301-332-4108
  • Fax: 410-234-8093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberD0056748
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: