Healthcare Provider Details

I. General information

NPI: 1851852412
Provider Name (Legal Business Name): ALLEGRA BERNARDO MATOOK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 HEALTH LN
WARWICK RI
02886-2710
US

IV. Provider business mailing address

455 TOLL GATE RD PRC AND CREDENTIALING
WARWICK RI
02886-2759
US

V. Phone/Fax

Practice location:
  • Phone: 401-737-6050
  • Fax: 401-732-6210
Mailing address:
  • Phone: 401-273-0641
  • Fax: 401-273-2919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA01116
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: