Healthcare Provider Details

I. General information

NPI: 1508903089
Provider Name (Legal Business Name): WALTER CHARLES ALLAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 09/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 SCIENCE PARK RD
SCARBOROUGH ME
04074-7169
US

IV. Provider business mailing address

PO BOX 190
SCARBOROUGH ME
04070-0190
US

V. Phone/Fax

Practice location:
  • Phone: 207-883-4131
  • Fax: 207-885-0807
Mailing address:
  • Phone: 207-883-4131
  • Fax: 207-885-0807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number009434
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: