Healthcare Provider Details

I. General information

NPI: 1700450558
Provider Name (Legal Business Name): ALLARA MEDICAL GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9744 AVENEL FARM DR
POTOMAC MD
20854-5407
US

IV. Provider business mailing address

520 BROADWAY FL 7
NEW YORK NY
10012-4436
US

V. Phone/Fax

Practice location:
  • Phone: 240-988-3611
  • Fax:
Mailing address:
  • Phone: 201-564-5109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KENNETH ALAN BLANK
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 240-432-5123