Provider Demographics
NPI:1902932767
Name:BAKHOS, LISA LOVAS (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:LOVAS
Last Name:BAKHOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:LOVAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 9484
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02940-9484
Mailing Address - Country:US
Mailing Address - Phone:401-854-2500
Mailing Address - Fax:401-854-2519
Practice Address - Street 1:593 EDDY ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-519-1604
Practice Address - Fax:401-272-0538
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAL-221687208000000X
RIMD12383208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI07282008OtherBCBSRI
MA12/29/2008OtherTUFTS HEALTH PLAN
RI12292008OtherTUFTS
RILB69118Medicaid
RI04/15/2009OtherUNITED HEALTHCARE
RI007059893OtherMEDICARE
RI1962455022OtherUEMF GROUP NPI
RI1902932767OtherNPI
MA2146533OtherMA MEDICAID
RI939025129OtherUEMF GROUP RI MEDICARE