Healthcare Provider Details

I. General information

NPI: 1194068452
Provider Name (Legal Business Name): JOHN BRENDON MILLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2013
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 HOPKINS BAYVIEW CIR # 1B.7
BALTIMORE MD
21224-6821
US

IV. Provider business mailing address

9910 FRANKLIN SQUARE DR STE 2110
BALTIMORE MD
21236-4902
US

V. Phone/Fax

Practice location:
  • Phone: 410-550-8470
  • Fax: 410-550-1033
Mailing address:
  • Phone: 410-933-6423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberD84981
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: