Healthcare Provider Details

I. General information

NPI: 1215261318
Provider Name (Legal Business Name): CARLOTTA GORDON MILES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2009
Last Update Date: 09/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 CONNECTICUT AVE, NW #206
WASHINGTON DC
20008
US

IV. Provider business mailing address

3000 CONNECTICUT AVE, NW #206
WASHINGTON DC
20008
US

V. Phone/Fax

Practice location:
  • Phone: 202-462-0770
  • Fax: 202-291-8535
Mailing address:
  • Phone: 202-462-0770
  • Fax: 202-291-8535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberM.D.25398
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: