Healthcare Provider Details

I. General information

NPI: 1528572807
Provider Name (Legal Business Name): ELAINE ALLEN, DPM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2017
Last Update Date: 11/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 FOUR LEAF LN STE 11A
CHARLOTTESVILLE VA
22903-9203
US

IV. Provider business mailing address

1109 LOCUST AVE
CHARLOTTESVILLE VA
22901-4033
US

V. Phone/Fax

Practice location:
  • Phone: 434-242-8550
  • Fax:
Mailing address:
  • Phone: 404-518-8748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. ELAINE ALLEN
Title or Position: OWNER
Credential: DPM
Phone: 434-242-8550