Provider Demographics
NPI:1396785689
Name:CLEARY, ALISA M (DO)
Entity type:Individual
Prefix:DR
First Name:ALISA
Middle Name:M
Last Name:CLEARY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ALISA
Other - Middle Name:M
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:329 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1504
Mailing Address - Country:US
Mailing Address - Phone:207-307-3000
Mailing Address - Fax:207-907-1043
Practice Address - Street 1:329 WILSON ST
Practice Address - Street 2:
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-1504
Practice Address - Country:US
Practice Address - Phone:207-307-3000
Practice Address - Fax:207-907-1043
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDO1938204D00000X, 207Q00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM2544Medicare ID - Type Unspecified
MEF04354Medicare UPIN