Provider Demographics
NPI:1427141209
Name:TVERSKAYA, OLGA V (MD)
Entity type:Individual
Prefix:MRS
First Name:OLGA
Middle Name:V
Last Name:TVERSKAYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910
Mailing Address - Country:US
Mailing Address - Phone:401-943-9011
Mailing Address - Fax:401-464-4087
Practice Address - Street 1:1120 PARK AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910
Practice Address - Country:US
Practice Address - Phone:401-943-9011
Practice Address - Fax:401-464-4087
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD08952207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI204781OtherBLUECHIP
RI9020254Medicaid
RI202596OtherBLUE CROSS
RI050486377OtherTAX ID