Provider Demographics
NPI:1487948543
Name:ALLEN, KERI (MD)
Entity type:Individual
Prefix:DR
First Name:KERI
Middle Name:
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:PO BOX 503900
Mailing Address - Street 2:
Mailing Address - City:SAIPAN
Mailing Address - State:MP
Mailing Address - Zip Code:96950-3900
Mailing Address - Country:US
Mailing Address - Phone:670-235-9090
Mailing Address - Fax:670-235-9091
Practice Address - Street 1:BEACH RD AND MOOTY STREET
Practice Address - Street 2:
Practice Address - City:SAIPAN
Practice Address - State:MP
Practice Address - Zip Code:96950
Practice Address - Country:US
Practice Address - Phone:670-235-9090
Practice Address - Fax:670-235-9091
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MP0711207W00000X
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program