Provider Demographics
NPI:1063426252
Name:PROANO, ALLISON (PA)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:PROANO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:125 WHIPPLE ST STE 3
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-3258
Mailing Address - Country:US
Mailing Address - Phone:401-519-0337
Mailing Address - Fax:401-427-7795
Practice Address - Street 1:593 EDDY ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-444-4000
Practice Address - Fax:401-272-0538
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA00130363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7006460Medicaid
RI007006460OtherRI MEDICARE
RI970006092OtherRAILROAD MEDICARE
RI1962455022OtherUEMF NPI
RI30578-7OtherBLUECHIP
RI939025129OtherRI MEDICARE GROUP NUMBER
RI007058932OtherNPI
RI01/15/2008OtherNHPRI
RI408655OtherBCBSRI
RI7006460Medicaid