Healthcare Provider Details

I. General information

NPI: 1578106985
Provider Name (Legal Business Name): PATRICK ALLEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2019
Last Update Date: 10/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 W LEXINGTON ST
BALTIMORE MD
21201-1508
US

IV. Provider business mailing address

14965 FREDERICK RD APT A
WOODBINE MD
21797-8619
US

V. Phone/Fax

Practice location:
  • Phone: 410-706-3100
  • Fax:
Mailing address:
  • Phone: 443-388-2656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: