MEDICARE: MR. RAY TERUE ALLEN

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	171M00000X	Case Manager/Care Coordinator		DC

General Provider Information

NPI Number	:	1932800190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAY TERUE ALLEN

Provider Business Mailing Address
First Line	:	4860 FORT TOTTEN DR NE APT 36
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-7574
Country	:	US
Telephone Number	:	202-436-1367
Fax Number	:

Provider Business Practice Location Address
First Line	:	4860 FORT TOTTEN DR NE APT 36
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-7574
Country	:	US
Telephone Number	:	202-436-1367
Fax Number	:

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

Provider Enumeration Date	:	03/15/2023
Last Update Date	:	06/30/2023

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Directions to “ MR. RAY TERUE ALLEN ” Practice Location

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