MEDICARE: MIA CONNORS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1548105828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIA CONNORS

Provider Business Mailing Address
First Line	:	303 COLUMBUS AVE UNIT 701
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02116-5288
Country	:	US
Telephone Number	:	617-529-3683
Fax Number	:

Provider Business Practice Location Address
First Line	:	20500 SENECA MEADOWS PKWY
Second Line	:
City	:	GERMANTOWN
State	:	MD
Zip	:	20876-7008
Country	:	US
Telephone Number	:	301-916-8500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2026
Last Update Date	:	04/22/2026

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Directions to “ MIA CONNORS ” Practice Location

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