Healthcare Provider Details

I. General information

NPI: 1689673741
Provider Name (Legal Business Name): LORNETTE B MILLS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 12/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12070 OLD LINE CTR STE 200
WALDORF MD
20602-2503
US

IV. Provider business mailing address

12070 OLD LINE CTR STE 200
WALDORF MD
20602-2503
US

V. Phone/Fax

Practice location:
  • Phone: 301-645-8035
  • Fax: 301-645-5229
Mailing address:
  • Phone: 301-645-8035
  • Fax: 301-645-5229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberD0054766
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: