Healthcare Provider Details

I. General information

NPI: 1720137177
Provider Name (Legal Business Name): DENYSE MARIE ALLEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DENISE MARIE ALLEN M.D.

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 03/03/2020
Certification Date: 03/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 CORNWALL RD STE 201
LEBANON PA
17042-7480
US

IV. Provider business mailing address

1701 CORNWALL RD STE 201
LEBANON PA
17042-7480
US

V. Phone/Fax

Practice location:
  • Phone: 717-675-1780
  • Fax: 717-675-1787
Mailing address:
  • Phone: 717-675-1780
  • Fax: 717-675-1787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number170213
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberMD-032127-E
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD-032127-E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: