Healthcare Provider Details

I. General information

NPI: 1639174949
Provider Name (Legal Business Name): ALLEN LAURENCE CARL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 02/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1367 WASHINGTON AVE STE 200
ALBANY NY
12206-1043
US

IV. Provider business mailing address

1367 WASHINGTON AVE STE 200
ALBANY NY
12206-1043
US

V. Phone/Fax

Practice location:
  • Phone: 518-489-2666
  • Fax: 518-489-5933
Mailing address:
  • Phone: 518-489-2666
  • Fax: 518-489-5933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number143645
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number143645-0
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: