Provider Demographics
NPI:1851852412
Name:MATOOK, ALLEGRA BERNARDO (PA-C)
Entity type:Individual
Prefix:
First Name:ALLEGRA
Middle Name:BERNARDO
Last Name:MATOOK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:455 TOLL GATE RD
Mailing Address - Street 2:PRC AND CREDENTIALING
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-2759
Mailing Address - Country:US
Mailing Address - Phone:401-273-0641
Mailing Address - Fax:401-273-2919
Practice Address - Street 1:51 HEALTH LN
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2710
Practice Address - Country:US
Practice Address - Phone:401-737-6050
Practice Address - Fax:401-732-6210
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2025-06-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
RIPA01116363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant