Healthcare Provider Details

I. General information

NPI: 1730401159
Provider Name (Legal Business Name): JACQUELINE M MILLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2010
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 BINNEY ST
CAMBRIDGE MA
02142-1008
US

IV. Provider business mailing address

7550 WISCONSIN AVE FL 7
BETHESDA MD
20814-3559
US

V. Phone/Fax

Practice location:
  • Phone: 617-427-3732
  • Fax:
Mailing address:
  • Phone: 617-417-3732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD068631L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: