Healthcare Provider Details

I. General information

NPI: 1891779047
Provider Name (Legal Business Name): MARK WAYNE ALLEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 04/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 LAIDLEY ST HMG HOSPITALIST OFFICE
CHARLESTON WV
25301-1614
US

IV. Provider business mailing address

333 LAIDLEY ST HMG HOSPITALIST OFFICE
CHARLESTON WV
25301-1614
US

V. Phone/Fax

Practice location:
  • Phone: 304-347-6116
  • Fax: 304-347-6117
Mailing address:
  • Phone: 304-347-6116
  • Fax: 304-347-6117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number19909
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number19909
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number19909
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: