Provider Demographics
NPI:1366554339
Name:LIESS, ANGELA M (MD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:LIESS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:100 FODEN ROAD, WEST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2327
Mailing Address - Country:US
Mailing Address - Phone:207-828-0361
Mailing Address - Fax:207-874-1483
Practice Address - Street 1:84 MARGINAL WAY
Practice Address - Street 2:SUITE 1000
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101
Practice Address - Country:US
Practice Address - Phone:207-774-2445
Practice Address - Fax:207-523-8598
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-03-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOT20050182392084P0800X
ME0184432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry