Healthcare Provider Details

I. General information

NPI: 1164611703
Provider Name (Legal Business Name): LIANE MULLER, D.O., PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2007
Last Update Date: 10/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 MAIN ST SUITE A
BRIDGTON ME
04009
US

IV. Provider business mailing address

PO BOX 118
BRIDGTON ME
04009-0118
US

V. Phone/Fax

Practice location:
  • Phone: 207-647-2440
  • Fax: 207-647-3775
Mailing address:
  • Phone: 207-647-2440
  • Fax: 207-647-3775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number1869
License Number StateME

VIII. Authorized Official

Name: DR. LIANE MULLER
Title or Position: PRESIDENT
Credential: D.O.
Phone: 207-647-2440