Provider Demographics
NPI:1114124294
Name:HAYWARD, ALISON SCHROTH (MD)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:SCHROTH
Last Name:HAYWARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:
Other - Last Name:SCHROTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:125 WHIPPLE ST STE 3
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-3258
Mailing Address - Country:US
Mailing Address - Phone:401-444-5175
Mailing Address - Fax:
Practice Address - Street 1:593 EDDY ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-444-5175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT051334207P00000X
MA238636207P00000X
MN105465207P00000X
MN54438207P00000X
RIMD15872207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110084958AMedicaid
RIMD15872OtherLICENSE
MNENROLLEDMedicaid
CT001513340Medicaid
MNP00992446OtherRAILROAD MEDICARE
IAENROLLEDMedicaid
MNENROLLEDMedicaid
CT001513340Medicaid