Provider Demographics
NPI:1720137177
Name:ALLEN, DENYSE MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:DENYSE
Middle Name:MARIE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DENISE
Other - Middle Name:MARIE
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1701 CORNWALL RD STE 201
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-7480
Mailing Address - Country:US
Mailing Address - Phone:717-675-1780
Mailing Address - Fax:717-675-1787
Practice Address - Street 1:1701 CORNWALL RD STE 201
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7480
Practice Address - Country:US
Practice Address - Phone:717-675-1780
Practice Address - Fax:717-675-1787
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY170213207Q00000X
PAMD-032127-E2083P0901X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA03212100OtherBLUE CROSS-KEYSTONE
PA488777OtherBLUE SHIELD
PA001065331Medicaid
PAC34675Medicare UPIN
PA488777Medicare ID - Type Unspecified