Healthcare Provider Details

I. General information

NPI: 1407058308
Provider Name (Legal Business Name): BENJAMIN J MILLER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2007
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 STONER AVE STE 102
WESTMINSTER MD
21157-5662
US

IV. Provider business mailing address

295 STONER AVE STE 102
WESTMINSTER MD
21157-5662
US

V. Phone/Fax

Practice location:
  • Phone: 410-848-1818
  • Fax: 410-871-7964
Mailing address:
  • Phone: 410-848-1818
  • Fax: 410-871-7964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberH70947
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberH70947
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: