Provider Demographics
NPI:1700978293
Name:SIERRA, ALFONSO E (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFONSO
Middle Name:E
Last Name:SIERRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ALFONSO
Other - Middle Name:E
Other - Last Name:SIERRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:10 SEAVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-3627
Mailing Address - Country:US
Mailing Address - Phone:401-619-0116
Mailing Address - Fax:
Practice Address - Street 1:505 NASHUA RD
Practice Address - Street 2:
Practice Address - City:DRACUT
Practice Address - State:MA
Practice Address - Zip Code:01826-1929
Practice Address - Country:US
Practice Address - Phone:978-957-4300
Practice Address - Fax:978-957-3891
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA40721208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAI74253Medicare UPIN