Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | DO1938 | ME |
Y | 207Q00000X | Family Doctor | DO1938 | ME |
NPI | 1396785689 |
---|---|
Provider Name | Dr. Alisa M Cleary |
First Address | Brewer, ME 04412-1504 |
Second Address | Brewer, ME 04412-1504 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 30/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F04354 | (02) | ME |