Provider Demographics
NPI:1366739930
Name:DOUMANOVSKAIA, LIIA EDOUARDOVNA (MD)
Entity type:Individual
Prefix:DR
First Name:LIIA
Middle Name:EDOUARDOVNA
Last Name:DOUMANOVSKAIA
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Gender:F
Credentials:MD
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Mailing Address - Street 1:12 HIGH ST STE 400
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7690
Mailing Address - Country:US
Mailing Address - Phone:207-795-5700
Mailing Address - Fax:207-795-5727
Practice Address - Street 1:194 E MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT KENT
Practice Address - State:ME
Practice Address - Zip Code:04743-1428
Practice Address - Country:US
Practice Address - Phone:207-834-1581
Practice Address - Fax:207-834-2949
Is Sole Proprietor?:No
Enumeration Date:2011-07-05
Last Update Date:2020-08-25
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Provider Licenses
StateLicense IDTaxonomies
ME018838207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine