Provider Demographics
NPI:1912059320
Name:ALLEN, VANESSA MARIA (MD)
Entity type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:MARIA
Last Name:ALLEN
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Gender:F
Credentials:MD
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Mailing Address - Street 1:12200 ANNAPOLIS RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-9182
Mailing Address - Country:US
Mailing Address - Phone:301-805-7084
Mailing Address - Fax:301-805-7043
Practice Address - Street 1:12200 ANNAPOLIS RD
Practice Address - Street 2:SUITE 115
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-9182
Practice Address - Country:US
Practice Address - Phone:301-805-7084
Practice Address - Fax:301-805-7043
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2013-02-20
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Provider Licenses
StateLicense IDTaxonomies
MDD0044864207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF42262Medicare UPIN