Provider Demographics
NPI:1083634687
Name:BIERMANN, MARLY LEIGH (MD)
Entity Type:Individual
Prefix:
First Name:MARLY
Middle Name:LEIGH
Last Name:BIERMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARLY
Other - Middle Name:LEIGH
Other - Last Name:LARRABEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:300 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240
Mailing Address - Country:US
Mailing Address - Phone:207-795-7575
Mailing Address - Fax:207-344-0350
Practice Address - Street 1:300 MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240
Practice Address - Country:US
Practice Address - Phone:207-795-7575
Practice Address - Fax:207-344-0350
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME017492208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME00027602Medicare UPIN