Provider Demographics
NPI:1447226022
Name:MENARD-MANLOVE, LISA M (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:M
Last Name:MENARD-MANLOVE
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 1:823 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOPE VALLEY
Mailing Address - State:RI
Mailing Address - Zip Code:02832-1920
Mailing Address - Country:US
Mailing Address - Phone:401-539-2461
Mailing Address - Fax:401-539-2663
Practice Address - Street 1:823 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOPE VALLEY
Practice Address - State:RI
Practice Address - Zip Code:02832-1920
Practice Address - Country:US
Practice Address - Phone:401-539-2461
Practice Address - Fax:401-539-2663
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD11236207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7010650Medicaid
RI7010650Medicaid