Provider Demographics
NPI:1932103306
Name:ALLEN, AMBER L (MD)
Entity type:Individual
Prefix:MS
First Name:AMBER
Middle Name:L
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 1:225 S PINE ST, JMB, 2ND FLR
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274
Mailing Address - Country:US
Mailing Address - Phone:812-523-7466
Mailing Address - Fax:812-523-7471
Practice Address - Street 1:225 S PINE ST, JMB, 2ND FLR
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274
Practice Address - Country:US
Practice Address - Phone:812-523-7466
Practice Address - Fax:812-523-7471
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN65194208000000X
KY52968208000000X
IN01044178A208000000X
VA0101274672208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0114037Medicaid
IN200149370Medicaid
IN000000898560OtherANTHEM
IN200149370Medicaid