Provider Demographics
NPI:1164611703
Name:LIANE MULLER, D.O., PA
Entity Type:Organization
Organization Name:LIANE MULLER, D.O., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:207-647-2440
Mailing Address - Street 1:PO BOX 118
Mailing Address - Street 2:
Mailing Address - City:BRIDGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04009-0118
Mailing Address - Country:US
Mailing Address - Phone:207-647-2440
Mailing Address - Fax:207-647-3775
Practice Address - Street 1:63 MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:BRIDGTON
Practice Address - State:ME
Practice Address - Zip Code:04009
Practice Address - Country:US
Practice Address - Phone:207-647-2440
Practice Address - Fax:207-647-3775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1869261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
1127587OtherAETNA
099629OtherANTHEM
ME431995900Medicaid
I33516OtherHARVARD PILGRIM
5488624OtherCIGNA
ME431995900Medicaid