Individual
MARK EDWARD ALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
800 INDEPENDENCE BLVD, VIRGINIA BEACH, VA 23455-6005
(757) 363-6230
(757) 363-6204
Mailing address
3998 FAIR RIDGE DR, STE 300, FAIRFAX, VA 22033-2907
(703) 766-9737
(703) 766-9725
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
0024166765
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11919377
CAQH
VA
Enumeration date
01/18/2006
Last updated
12/23/2014
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