Basic Information
| Provider Information | |||||||||
| NPI: | 1114124294 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAYWARD | ||||||||
| FirstName: | ALISON | ||||||||
| MiddleName: | SCHROTH | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SCHROTH | ||||||||
| OtherFirstName: | ALISON | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 125 WHIPPLE ST STE 3 | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029083258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014445175 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 593 EDDY ST | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029034923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014445175 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 051334 | CT | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 238636 | MA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 105465 | MN | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 54438 | MN | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | MD15872 | RI | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 110084958A | 05 | MA | MEDICAID | MD15872 | 01 | RI | LICENSE | OTHER | ENROLLED | 05 | MN | MEDICAID | 001513340 | 05 | CT | MEDICAID | P00992446 | 01 | MN | RAILROAD MEDICARE | OTHER | ENROLLED | 05 | IA | MEDICAID |