Provider Demographics
NPI:1962509554
Name:KALLOR, ALLEN DAVID (MD)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:DAVID
Last Name:KALLOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 HART ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06052-1743
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:40 HART ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-1743
Practice Address - Country:US
Practice Address - Phone:860-225-7895
Practice Address - Fax:860-826-1407
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT20138207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0V0465OtherHEALTHNET
CT0468330OtherAETNA
CT052550OtherCONNECTICARE
CT0679777003OtherCIGNA
CT0012013883Medicaid
CTP704158OtherOXFORD
CT010020138CT01OtherANTHEM BC/BS
CTCT020138OtherUNITED HEALTH
CTB83577Medicare UPIN