Healthcare Provider Details

I. General information

NPI: 1336961036
Provider Name (Legal Business Name): ALLEN STALLINGS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2024
Last Update Date: 10/25/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10440 LITTLE PATUXENT PKWY
COLUMBIA MD
21044-3561
US

IV. Provider business mailing address

10440 LITTLE PATUXENT PKWY
COLUMBIA MD
21044-3561
US

V. Phone/Fax

Practice location:
  • Phone: 443-656-9050
  • Fax: 617-340-3371
Mailing address:
  • Phone: 443-656-9050
  • Fax: 617-340-3371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: