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NPI Code Detail

MEDICARE: MARY JUDITH ALLEN D.O.

MEDICARE: MARY JUDITH 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
12080N0001XNeonatal-Perinatal Medicine Physician51615GA

General Provider Information

NPI Number : 1427077759
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY JUDITH ALLEN D.O.
Provider Business Mailing Address
First Line : 13592 WAYNESFIELD RD
Second Line :
City : WAPAKONETA
State : OH
Zip : 45895-8621
Country : US
Telephone Number : 419-305-5728
Fax Number :
Provider Business Practice Location Address
First Line : 303 FRASER DR
Second Line :
City : HINESVILLE
State : GA
Zip : 31313-3712
Country : US
Telephone Number : 912-877-2227
Fax Number : 912-877-2332
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2006
Last Update Date : 10/01/2019

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