Provider Demographics
NPI:1821132432
Name:PANZINI, LISA (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:PANZINI
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 1:45 WELLS ST
Mailing Address - Street 2:
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-2961
Mailing Address - Country:US
Mailing Address - Phone:401-596-6000
Mailing Address - Fax:203-401-4687
Practice Address - Street 1:45 WELLS ST
Practice Address - Street 2:
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-2961
Practice Address - Country:US
Practice Address - Phone:203-777-0304
Practice Address - Fax:203-401-4687
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301510000207RG0100X
CODR.0070531207RG0100X
RIMD18660207RG0100X
CT030072207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001300722Medicaid
CT001300722Medicaid
CT100000309Medicare ID - Type Unspecified