Provider Demographics
NPI:1124686142
Name:ALLEN, JOSHUA MARK (DO)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:MARK
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:364 MAINE ST
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04274-5109
Mailing Address - Country:US
Mailing Address - Phone:207-998-2100
Mailing Address - Fax:207-998-5756
Practice Address - Street 1:364 MAINE ST
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:ME
Practice Address - Zip Code:04274-5109
Practice Address - Country:US
Practice Address - Phone:207-998-2100
Practice Address - Fax:207-998-5756
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDO3383207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program