Provider Demographics
NPI:1184690299
Name:LA PROVA, GINA GERARDINE (MD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:GERARDINE
Last Name:LA PROVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2140 MENDON RD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-3843
Mailing Address - Country:US
Mailing Address - Phone:401-642-2072
Mailing Address - Fax:401-305-3958
Practice Address - Street 1:2140 MENDON RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-3843
Practice Address - Country:US
Practice Address - Phone:401-642-2072
Practice Address - Fax:401-305-3958
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA224304207Q00000X
RIMD10894207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
92588701OtherNETWORK HEALTH
RI21435-7OtherBCBS OF RHODE ISLAND
AA309012OtherHARVARD PILGRIM
MA110083759AMedicaid
1184690299OtherNEIGHBORHOOD HEALTH PLAN
042297845OtherTRICARE
042297845OtherUNITED HEALTH CARE
042297845OtherHCVM
1184690299OtherFALLON
7981290OtherAETNA
010894OtherTUFTS AND TUFTS MED PREFERRED
042297845OtherGIC/UNICARE
MAJ46491OtherBCBSMA