Marcus Allen, MD
Individual provider Active NPI Diagnostic Radiology Physician · Liverpool, NY
NPI 1891787909 · NPPES record last updated Sep 13, 2007
Key facts
- NPI
- 1891787909
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Diagnostic Radiology Physician 2085R0202X
- License
- 157868 (NY)
- Practice address
- 5100 W Taft Rd
Suite 2a
Liverpool, NY 13088-3807 - Phone
- (315) 452-2555
- Fax
- (315) 452-2559
- NPI assigned
- Aug 16, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 157868 | NY | MD | Diagnostic Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mohawk Glen Radiology Associates of Cny PLLC | Diagnostic Radiology | Past | Accepting new patients |
| Central New York Pet LLC | Past |
Accepting new patients | |
| Prospect Hill Radiology Group P C | Diagnostic Radiology | Past | Accepting new patients |
| St. Josephs Imaging Associates PLLC | Diagnostic Radiology | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 157868 | NY | Yes |
Addresses
Primary practice location
5100 W Taft Rd
Suite 2a
Liverpool, NY 13088-3807
Mailing address
4567 Crossroads Park Dr
2ND Floor
Liverpool, NY 13088-3589
Phone (315) 295-2100
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02224500 | Medicaid | NY | |
| 00555500 | Medicaid | NY | |
| 00842728 | Medicaid | NY | |
| 00555440 | Medicaid | NY |
Other providers in Liverpool, NY
- Sophie Alesna-Sabang
- Hani Alkhouri
- Scott Allan
- James Crawford Allanson III
- Lia Allen
- Robert B Allen
- Maritza Alvarado
- Christy J Amidon
- Mark David Amisano
- Robert P. Amitrano
All providers in Liverpool, NY · Diagnostic Radiology Physician in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 13, 2007. 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.