Healthcare Provider Details

I. General information

NPI: 1730482464
Provider Name (Legal Business Name): NOAH J MILLER CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2010
Last Update Date: 06/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7207 BALTIMORE ANNAPOLIS BLVD
GLEN BURNIE MD
21061-2684
US

IV. Provider business mailing address

4201 PRIMROSE AVE
BALTIMORE MD
21215-3305
US

V. Phone/Fax

Practice location:
  • Phone: 410-768-0123
  • Fax: 410-768-1716
Mailing address:
  • Phone: 410-764-8560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR169251
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: