Healthcare Provider Details

I. General information

NPI: 1366412579
Provider Name (Legal Business Name): AMY MARIE MILLIKAN MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 ROBERT GRANT AVE
SILVER SPRING MD
20910-7500
US

IV. Provider business mailing address

15129 DEER VALLEY TER
SILVER SPRING MD
20906-6224
US

V. Phone/Fax

Practice location:
  • Phone: 301-319-9916
  • Fax: 301-319-9104
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number0101233023
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: