Provider Demographics
NPI:1508186354
Name:NIEMIEC, ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:NIEMIEC
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 1:37 BELLEVUE AVE UNIT F
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-3207
Mailing Address - Country:US
Mailing Address - Phone:401-324-9105
Mailing Address - Fax:717-200-9787
Practice Address - Street 1:37 BELLEVUE AVE UNIT F
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-3207
Practice Address - Country:US
Practice Address - Phone:401-324-9105
Practice Address - Fax:717-200-9787
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042.00139262084P0800X
RIMD146442084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry