Healthcare Provider Details

I. General information

NPI: 1265793574
Provider Name (Legal Business Name): ADAM LIEGNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2012
Last Update Date: 09/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 HORTON PL SUITE 101
TOPSHAM ME
04086-1747
US

IV. Provider business mailing address

4 HORTON PL SUITE 101
TOPSHAM ME
04086-1747
US

V. Phone/Fax

Practice location:
  • Phone: 207-798-6200
  • Fax: 207-798-6290
Mailing address:
  • Phone: 207-798-6200
  • Fax: 207-798-6290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD20819
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: