Provider Demographics
NPI:1861652349
Name:AGUIAR, LIZA M (MD)
Entity Type:Individual
Prefix:
First Name:LIZA
Middle Name:M
Last Name:AGUIAR
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 1:195 COLLYER ST 201
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-1869
Mailing Address - Country:US
Mailing Address - Phone:401-276-2002
Mailing Address - Fax:401-272-9299
Practice Address - Street 1:195 COLLYER ST 201
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-1869
Practice Address - Country:US
Practice Address - Phone:401-276-2002
Practice Address - Fax:401-272-9299
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
RIMD150992088P0231X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology