Provider Demographics
NPI:1639432180
Name:HAUSPURG-JANICKI, ALISSE K (MD)
Entity type:Individual
Prefix:
First Name:ALISSE
Middle Name:K
Last Name:HAUSPURG-JANICKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALISSE
Other - Middle Name:K
Other - Last Name:HAUSPURG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:101 DUDLEY ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-2401
Mailing Address - Country:US
Mailing Address - Phone:401-273-0641
Mailing Address - Fax:
Practice Address - Street 1:101 PLAIN ST FL 6
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4829
Practice Address - Country:US
Practice Address - Phone:401-274-1122
Practice Address - Fax:401-453-7622
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD19760207V00000X, 207VM0101X
MA1020240207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology