Healthcare Provider Details

I. General information

NPI: 1740327410
Provider Name (Legal Business Name): LISA ANN MILLS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 E MONUMENT ST ROOM 402
BALTIMORE MD
21205-2100
US

IV. Provider business mailing address

1830 E MONUMENT ST ROOM 402
BALTIMORE MD
21205-2100
US

V. Phone/Fax

Practice location:
  • Phone: 410-283-9908
  • Fax: 410-955-7889
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberP20189
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: