MEDICARE: DR. GREGORY G ALLEN D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	DO 00582	RI

General Provider Information

NPI Number	:	1043217250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY G ALLEN D.O.

Provider Business Mailing Address
First Line	:	1681 CRANSTON ST
Second Line	:	SUITE D
City	:	CRANSTON
State	:	RI
Zip	:	02920-5000
Country	:	US
Telephone Number	:	401-946-8446
Fax Number	:	401-946-8340

Provider Business Practice Location Address
First Line	:	1681 CRANSTON ST
Second Line	:	SUITE D
City	:	CRANSTON
State	:	RI
Zip	:	02920-5000
Country	:	US
Telephone Number	:	401-946-8446
Fax Number	:	401-946-8340

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	08/28/2007

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