Healthcare Provider Details

I. General information

NPI: 1659511749
Provider Name (Legal Business Name): ALLISON W ALLEN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2009
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 INDUSTRIAL AVE STE 101
SANFORD ME
04073-5846
US

IV. Provider business mailing address

27 INDUSTRIAL AVE STE 101
SANFORD ME
04073-5846
US

V. Phone/Fax

Practice location:
  • Phone: 207-459-1666
  • Fax: 207-661-8537
Mailing address:
  • Phone: 207-459-1666
  • Fax: 207-661-8537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0746
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0746
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA3145
License Number StateME
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA3145
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: