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1891779047

NPI Code Detail

MEDICARE: MARK WAYNE ALLEN MD

MEDICARE: MARK WAYNE ALLEN MD

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	208000000X	Pediatrics Physician	19909	WV
2	207Q00000X	Family Medicine Physician	19909	WV
3	207P00000X	Emergency Medicine Physician	19909	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1891779047	OTHER	WV	BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891779047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK WAYNE ALLEN MD

Provider Business Mailing Address
First Line	:	333 LAIDLEY ST
Second Line	:	HMG HOSPITALIST OFFICE
City	:	CHARLESTON
State	:	WV
Zip	:	25301-1614
Country	:	US
Telephone Number	:	304-347-6116
Fax Number	:	304-347-6117

Provider Business Practice Location Address
First Line	:	333 LAIDLEY ST
Second Line	:	HMG HOSPITALIST OFFICE
City	:	CHARLESTON
State	:	WV
Zip	:	25301-1614
Country	:	US
Telephone Number	:	304-347-6116
Fax Number	:	304-347-6117

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

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	04/19/2010

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Directions to “ MARK WAYNE ALLEN MD” Practice Location

Language	Start Address	Practice Location

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