Provider Demographics
NPI:1124089818
Name:ALLEN, NANCY A (MD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:A
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 FOOTE AVE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-6800
Mailing Address - Country:US
Mailing Address - Phone:716-484-9194
Mailing Address - Fax:716-484-0115
Practice Address - Street 1:400 FOOTE AVE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-6800
Practice Address - Country:US
Practice Address - Phone:716-484-9194
Practice Address - Fax:716-484-0115
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199070207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY040426003830OtherFIDELIS CARE
NY000524873001OtherBC/BS OF WNY
NY00010304601OtherUNIVERA
NY01746794Medicaid
NY000524873001OtherBC/BS OF WNY
NY00010304601OtherUNIVERA