Provider Demographics
NPI:1295782787
Name:DOMAGALSKI, LISA R (MD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:R
Last Name:DOMAGALSKI
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:333 SCHOOL STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860
Mailing Address - Country:US
Mailing Address - Phone:401-724-0600
Mailing Address - Fax:401-724-8306
Practice Address - Street 1:333 SCHOOL STREET
Practice Address - Street 2:SUITE 205
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860
Practice Address - Country:US
Practice Address - Phone:401-724-0600
Practice Address - Fax:401-724-8306
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2021-03-30
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Provider Licenses
StateLicense IDTaxonomies
RIMD8389207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7004719Medicaid
G04983Medicare UPIN