Provider Demographics
NPI:1316259435
Name:MUKAND-CERRO, IAN (MD)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:
Last Name:MUKAND-CERRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 STATE ST STE 439
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6635
Mailing Address - Country:US
Mailing Address - Phone:207-941-8200
Mailing Address - Fax:207-990-4848
Practice Address - Street 1:417 STATE ST STE 439
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6635
Practice Address - Country:US
Practice Address - Phone:207-941-8200
Practice Address - Fax:207-990-4848
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA258041207ZP0102X
WV28520207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology