Provider Demographics
NPI:1023214525
Name:ALLEGRA, MARISA I (MD)
Entity Type:Individual
Prefix:DR
First Name:MARISA
Middle Name:I
Last Name:ALLEGRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1 RANDALL SQUARE
Mailing Address - Street 2:SUITE 407
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-7405
Mailing Address - Country:US
Mailing Address - Phone:401-421-6711
Mailing Address - Fax:401-272-2919
Practice Address - Street 1:1 RANDALL SQUARE
Practice Address - Street 2:SUITE 407
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-7405
Practice Address - Country:US
Practice Address - Phone:401-421-6711
Practice Address - Fax:401-272-2919
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RI0049812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
C90728Medicare UPIN