Healthcare Provider Details

I. General information

NPI: 1700978293
Provider Name (Legal Business Name): ALFONSO E. SIERRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ALFONSO E. SIERRA M.D.

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 NASHUA RD
DRACUT MA
01826-1929
US

IV. Provider business mailing address

10 SEAVIEW AVE
NEWPORT RI
02840-3627
US

V. Phone/Fax

Practice location:
  • Phone: 978-957-4300
  • Fax: 978-957-3891
Mailing address:
  • Phone: 401-619-0116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number40721
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: