Active NPI
Charles D Allen, MD
- Surgery Physician
- Medford, MA
National Provider Identifier
1720063142
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 40486
- Practice address
- 49 Governors Ave
Medford, MA 02155-3017 - Phone
- (781) 395-6122
- Fax
- (781) 395-2595
- NPI assigned
- Dec 8, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 40486 | MA | Primary |
Addresses
Primary practice location
49 Governors Ave
Medford, MA 02155-3017
Mailing address
49 Governors Ave
Medford, MA 02155-3017
Phone (781) 395-6122
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| B53097 | Other | MA | BCBS |
| 040486 | Other | MA | TUFTS |
| 8475 | Other | MA | HARVARD PIL |
| 2058502 | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40486 | MA | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1134000000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1720063142",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "49 GOVERNORS AVE",
"city": "MEDFORD",
"state": "MA",
"postal_code": "021553017",
"telephone_number": "781-395-6122",
"fax_number": "781-395-2595"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "49 GOVERNORS AVE",
"city": "MEDFORD",
"state": "MA",
"postal_code": "021553017",
"telephone_number": "781-395-6122",
"fax_number": "781-395-2595"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ALLEN",
"first_name": "CHARLES",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-08",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "MA",
"license": "40486",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "B53097",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS",
"identifier": "040486",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HARVARD PIL",
"identifier": "8475",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2058502",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Medford, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.