Healthcare Provider Details

I. General information

NPI: 1821399239
Provider Name (Legal Business Name): TIMOTHY JUSTIN MILLER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2010
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8926 WOODYARD RD STE 301
CLINTON MD
20735-4220
US

IV. Provider business mailing address

7801 OLD BRANCH AVE STE 300
CLINTON MD
20735-1608
US

V. Phone/Fax

Practice location:
  • Phone: 301-856-3670
  • Fax: 301-868-0129
Mailing address:
  • Phone: 301-856-6718
  • Fax: 301-856-6599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberH0081237
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number19096
License Number StateND
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number15141C
License Number StateWY
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0102202428
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: