Healthcare Provider Details

I. General information

NPI: 1346376035
Provider Name (Legal Business Name): KENNETH SCOTT ALLEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL PARK
WHEELING WV
26003-6379
US

IV. Provider business mailing address

PO BOX 6732
WHEELING WV
26003-0656
US

V. Phone/Fax

Practice location:
  • Phone: 304-233-2455
  • Fax: 304-233-6073
Mailing address:
  • Phone: 304-233-2455
  • Fax: 304-233-6073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number17749
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: