Provider Demographics
NPI:1417997818
Name:LIANSKI, MAXIM (MD)
Entity Type:Individual
Prefix:DR
First Name:MAXIM
Middle Name:
Last Name:LIANSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 GOVERNORS AVE
Mailing Address - Street 2:LAWRENCE MEMORIAL HOSPITAL
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-1643
Mailing Address - Country:US
Mailing Address - Phone:781-306-6164
Mailing Address - Fax:781-306-6146
Practice Address - Street 1:170 GOVERNORS AVE
Practice Address - Street 2:LAWRENCE MEMORIAL HOSPITAL
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-1643
Practice Address - Country:US
Practice Address - Phone:781-306-6164
Practice Address - Fax:781-306-6146
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2228952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ28215OtherBLUE CROSS BLUE SHIELD
MAI20840Medicare UPIN
MAJ28215OtherBLUE CROSS BLUE SHIELD