Provider Demographics
NPI:1023070695
Name:HAINES, LISA MILLER (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MILLER
Last Name:HAINES
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 1:1351 S COUNTY TRL
Mailing Address - Street 2:SUITE 205
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-5079
Mailing Address - Country:US
Mailing Address - Phone:401-886-7881
Mailing Address - Fax:401-886-7883
Practice Address - Street 1:1351 S COUNTY TRL
Practice Address - Street 2:SUITE 205
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-5079
Practice Address - Country:US
Practice Address - Phone:401-886-7881
Practice Address - Fax:401-886-7883
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD09866208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
G89068Medicare UPIN