Healthcare Provider Details

I. General information

NPI: 1346411881
Provider Name (Legal Business Name): HARVEY ALLEN SR. MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2008
Last Update Date: 03/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

491 N CLEVELAND AVE
WINSTON SALEM NC
27101-4334
US

IV. Provider business mailing address

491 N CLEVELAND AVE
WINSTON SALEM NC
27101-4334
US

V. Phone/Fax

Practice location:
  • Phone: 336-659-9440
  • Fax: 336-659-9845
Mailing address:
  • Phone: 336-659-9440
  • Fax: 336-659-9845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14550
License Number StateNC

VIII. Authorized Official

Name: HARVEY ALLEN SR.
Title or Position: OWNER
Credential: MD
Phone: 336-659-9440