Provider Demographics
NPI:1669433942
Name:KORENNAYA, ALLA (MD)
Entity type:Individual
Prefix:DR
First Name:ALLA
Middle Name:
Last Name:KORENNAYA
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 1:175 NATE WHIPPLE HWY
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-1416
Mailing Address - Country:US
Mailing Address - Phone:401-658-3600
Mailing Address - Fax:401-405-0586
Practice Address - Street 1:175 NATE WHIPPLE HWY
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-1416
Practice Address - Country:US
Practice Address - Phone:401-658-3600
Practice Address - Fax:401-405-0586
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI093582084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI009358OtherTUFTS HEALTH PLAN
RI1795OtherNEIGHBORHOOD HEALTH PLAN
RI9020432Medicaid
RI130019637OtherRAILROAD MEDICARE
RI401008OtherBLUE CHIP
RI720065101OtherCIGNA HELATH CARE
RI0500012OtherUNITEDHEALTH CARE
RI204321OtherBLUE CROSS BLUE SHIELD
RI130019637OtherRAILROAD MEDICARE
RIG47760Medicare UPIN