Healthcare Provider Details

I. General information

NPI: 1043678444
Provider Name (Legal Business Name): SHAWN JAMISON MILLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: SHAWN JAMISON MILLER MD

II. Dates (important events)

Enumeration Date: 02/01/2016
Last Update Date: 07/16/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4494 PALMER RD N
BETHESDA MD
20814
US

IV. Provider business mailing address

1363 ROCKBRIDGE AVE
NORFOLK VA
23508-1339
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-9046
  • Fax:
Mailing address:
  • Phone: 864-906-1946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101263022
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateSC
# 4
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number0101263022
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: