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Individual

DR. LISA LOVAS BAKHOS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
593 EDDY ST, PROVIDENCE, RI 02903-4923
(401) 519-1604
(401) 272-0538
Mailing address
PO BOX 9484, PROVIDENCE, RI 02940-9484
(401) 854-2500
(401) 854-2519

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
L-221687
MA
208000000X
Pediatrics Physician
Primary
MD12383
RI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
007059893
MEDICARE
RI
01
04/15/2009
UNITED HEALTHCARE
RI
01
07282008
BCBSRI
RI
01
12/29/2008
TUFTS HEALTH PLAN
MA
01
12292008
TUFTS
RI
01
1902932767
NPI
RI
01
1962455022
UEMF GROUP NPI
RI
01
2146533
MA MEDICAID
MA
01
939025129
UEMF GROUP RI MEDICARE
RI
05
LB69118
RI
Enumeration date
02/26/2007
Last updated
02/05/2010
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