Healthcare Provider Details

I. General information

NPI: 1548077720
Provider Name (Legal Business Name): JOSHUA THOMAS MILLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2024
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E NORTH AVE
BALTIMORE MD
21202-4888
US

IV. Provider business mailing address

200 E NORTH AVE RM 211
BALTIMORE MD
21202-4888
US

V. Phone/Fax

Practice location:
  • Phone: 410-396-8700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number30-8654
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: