Provider Demographics
NPI:1487694394
Name:ALLEN, PRUDENCE (MD)
Entity type:Individual
Prefix:DR
First Name:PRUDENCE
Middle Name:
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 1:85 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOPKINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01748
Mailing Address - Country:US
Mailing Address - Phone:508-435-4415
Mailing Address - Fax:508-435-8254
Practice Address - Street 1:85 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOPKINTON
Practice Address - State:MA
Practice Address - Zip Code:01748
Practice Address - Country:US
Practice Address - Phone:508-435-4415
Practice Address - Fax:508-435-8254
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA349542084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2052717Medicaid
MA2052717Medicaid
B72983Medicare UPIN