Provider Demographics
NPI:1720190267
Name:MATSIEVSKAYA, ALLA (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLA
Middle Name:
Last Name:MATSIEVSKAYA
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 1:430 TOLL GATE RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-2715
Mailing Address - Country:US
Mailing Address - Phone:401-737-4343
Mailing Address - Fax:401-734-9365
Practice Address - Street 1:430 TOLL GATE RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2715
Practice Address - Country:US
Practice Address - Phone:401-737-4343
Practice Address - Fax:401-734-9365
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD09819208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI201848OtherHARVARD PILGRIM HEALTH
RI2499938OtherAETNA
RI12-06001OtherUNITED HEALTH CARE
RIRI2988OtherACS/HEALTHNET
RI403352OtherBLUE CHIP
RIAM35406Medicaid
RI1920OtherNEIGHBORHOOD HEALTH
RI23287-4OtherBLUE CROSS BLUE SHIELD RI
RI406471OtherTUFTS
RIRI2988OtherACS/HEALTHNET
RI23287-4OtherBLUE CROSS BLUE SHIELD RI
RI007006701Medicare ID - Type Unspecified