Provider Demographics
NPI:1457358343
Name:REISER, BARBARA (MD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:REISER
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 1:275 BROADWAY UNIT 2
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-2612
Mailing Address - Country:US
Mailing Address - Phone:401-845-1472
Mailing Address - Fax:401-846-4874
Practice Address - Street 1:11 FRIENDSHIP ST
Practice Address - Street 2:TURNER 1
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-2209
Practice Address - Country:US
Practice Address - Phone:401-845-1652
Practice Address - Fax:401-845-1198
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD07893208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7001086Medicaid
7001086Medicare ID - Type Unspecified
RI7001086Medicaid