Provider Demographics
NPI:1629377155
Name:ALLEN, CASEY JACKSON (MD)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:JACKSON
Last Name:ALLEN
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 1:314 E NORTH AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4737
Mailing Address - Country:US
Mailing Address - Phone:833-246-7662
Mailing Address - Fax:412-442-2323
Practice Address - Street 1:314 E NORTH AVE FL 1
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4737
Practice Address - Country:US
Practice Address - Phone:833-246-7662
Practice Address - Fax:412-442-2323
Is Sole Proprietor?:No
Enumeration Date:2011-03-23
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD474644208600000X
TXR7374208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX391359201Medicaid
TX391359202OtherMEDICAID CSHCN
TX8JZ945OtherBCBS
TXQ00039053OtherRAILROAD MEDICARE