Healthcare Provider Details

I. General information

NPI: 1457670002
Provider Name (Legal Business Name): AMARIS H ALLAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2010
Last Update Date: 01/09/2021
Certification Date: 01/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3156 KENSINGTON AVE STE 1
PHILADELPHIA PA
19134-2400
US

IV. Provider business mailing address

120 S TAN ALY STE 1
FREDERICKSBURG PA
17026-9349
US

V. Phone/Fax

Practice location:
  • Phone: 215-831-1100
  • Fax: 215-807-8951
Mailing address:
  • Phone: 717-865-6644
  • Fax: 717-865-5666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT196943
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD447774
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: