Provider Demographics
NPI:1174951263
Name:ALLEN, ANDRIA M (DO)
Entity type:Individual
Prefix:DR
First Name:ANDRIA
Middle Name:M
Last Name:ALLEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:ANDRIA
Other - Middle Name:M
Other - Last Name:PAINTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:420 CHARLESTON DR STE B
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25271-1714
Mailing Address - Country:US
Mailing Address - Phone:681-661-0123
Mailing Address - Fax:833-431-1250
Practice Address - Street 1:420 CHARLESTON DR STE B
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:WV
Practice Address - Zip Code:25271-1714
Practice Address - Country:US
Practice Address - Phone:681-661-0123
Practice Address - Fax:833-431-1250
Is Sole Proprietor?:No
Enumeration Date:2013-10-29
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3139207Q00000X
PA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA487682YUNMMedicare PIN
PA487682YEBKMedicare PIN