Provider Demographics
NPI:1518909613
Name:ALLEN, MARIAN C (MD)
Entity type:Individual
Prefix:
First Name:MARIAN
Middle Name:C
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 1:3430 BAXTER VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-2417
Mailing Address - Country:US
Mailing Address - Phone:832-549-5704
Mailing Address - Fax:
Practice Address - Street 1:2255 E MOSSY OAKS RD STE 320
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77389-1812
Practice Address - Country:US
Practice Address - Phone:936-266-2195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0133207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080136655OtherMEDICARE RAILROAD
TX1226870-03Medicaid
TX80263NMedicare PIN
TX080136655OtherMEDICARE RAILROAD