Provider Demographics
NPI:1245565738
Name:ANGELINI, LIA O (MT)
Entity Type:Individual
Prefix:
First Name:LIA
Middle Name:O
Last Name:ANGELINI
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:484 MAINE AVE STE 2D
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:ME
Mailing Address - Zip Code:04344-2903
Mailing Address - Country:US
Mailing Address - Phone:207-582-2323
Mailing Address - Fax:207-588-0294
Practice Address - Street 1:484 MAINE AVE STE 2D
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:ME
Practice Address - Zip Code:04344-2903
Practice Address - Country:US
Practice Address - Phone:207-582-2323
Practice Address - Fax:207-588-0294
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT1762174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist