MEDICARE: MS. MORGAN STUART ALLEN PNP

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	207PP0204X	Pediatric Emergency Medicine (Emergency Medicine) Physician	0024176601	VA

General Provider Information

NPI Number	:	1801363767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MORGAN STUART ALLEN PNP

Provider Business Mailing Address
First Line	:	5855 BREMO RD STE 210
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23226-1922
Country	:	US
Telephone Number	:	804-287-7066
Fax Number	:	804-673-9531

Provider Business Practice Location Address
First Line	:	5855 BREMO RD STE 210
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23226-1922
Country	:	US
Telephone Number	:	804-287-7066
Fax Number	:	804-673-9531

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

Provider Enumeration Date	:	10/30/2018
Last Update Date	:	10/30/2018

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