Mark Wayne Allen, MD
Individual provider Active NPI Family Medicine Physician · Charleston, WV
NPI 1891779047 · NPPES record last updated Apr 19, 2010
Key facts
- NPI
- 1891779047
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 19909 (WV)
- Practice address
- 333 Laidley St
HMG Hospitalist Office
Charleston, WV 25301-1614 - Phone
- (304) 347-6116
- Fax
- (304) 347-6117
- NPI assigned
- Dec 1, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19909 | WV | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hospitalist Medicine Physicians of Charleston, PLLC | Past | Accepting new patients | |
| Integrated Health Care Providers | Past | Accepting new patients | |
| Charleston Area Medical Center Inc | Past | Accepting new patients | |
| Sanjay Bharti MD PLLC | Past | Accepting new patients | |
| Cross Lanes Family Practice, Inc. (Lab) | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 19909 | WV | |
| Family Medicine Physician | 207Q00000X | 19909 | WV | Yes |
| Emergency Medicine Physician | 207P00000X | 19909 | WV |
Addresses
Primary practice location
333 Laidley St
HMG Hospitalist Office
Charleston, WV 25301-1614
Mailing address
333 Laidley St
HMG Hospitalist Office
Charleston, WV 25301-1614
Phone (304) 347-6116
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891779047 | Other | WV | BLUE SHIELD |
| 3002489000 | Medicaid | WV |
Other providers in Charleston, WV
- Kayla Allen
- Kayla Allen
- Kelsey Dawn Allen
- Lana G Allen
- Linda Allen
- Megan Allen
- Natalie F. Allen
- Shaikai Allen
- Shatesha Shanta Allen
- William Richard Allen
All providers in Charleston, WV · Family Medicine Physician in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 19, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.