Provider Demographics
NPI:1538187653
Name:SEFTEL, ALLEN (MD)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:
Last Name:SEFTEL
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 1:3 COOPER PLZ
Mailing Address - Street 2:SUTIE 502
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1438
Mailing Address - Country:US
Mailing Address - Phone:856-968-7433
Mailing Address - Fax:856-968-8499
Practice Address - Street 1:3 COOPER PLZ
Practice Address - Street 2:SUITE 411
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1438
Practice Address - Country:US
Practice Address - Phone:856-963-3577
Practice Address - Fax:856-963-8784
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-056249208800000X
NJMA08630800208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0065788OtherAETNA
OH0878395Medicaid
OH363998OtherWELLCARE
OHP00364285OtherRAILROAD MEDICARE
OH000000025070OtherANTHEM
OH000000507517OtherANTHEM
OH741849OtherBUCKEYE
OH000000221032OtherUNISON
NJMA08630800OtherSTATE LICENSE
OH85441339OtherTRICARE
OHF30254Medicare UPIN
OHSE4103456Medicare PIN
OH363998OtherWELLCARE