Healthcare Provider Details

I. General information

NPI: 1932615010
Provider Name (Legal Business Name): JEREMY MILLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2017
Last Update Date: 01/24/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 LASALLE RD SUITE 100
TOWSON MD
21286
US

IV. Provider business mailing address

8600 LASALLE RD SUITE 100 - POTOMAC BUILDING
TOWSON MD
21286
US

V. Phone/Fax

Practice location:
  • Phone: 443-921-4683
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0096690
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: