Healthcare Provider Details

I. General information

NPI: 1598505208
Provider Name (Legal Business Name): MARTINA ALLISON ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2024
Last Update Date: 06/24/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 FALLS DR NW
ABINGDON VA
24210-8093
US

IV. Provider business mailing address

319 FALLS DR.
ABINGTON VA
24210-8093
US

V. Phone/Fax

Practice location:
  • Phone: 276-676-1111
  • Fax:
Mailing address:
  • Phone: 276-676-1111
  • Fax: 276-676-1112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: