Healthcare Provider Details

I. General information

NPI: 1154324648
Provider Name (Legal Business Name): MARILYN DIANE MILLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 08/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 STONER AVE STE 205
WESTMINSTER MD
21157-5637
US

IV. Provider business mailing address

295 STONER AVE STE 205
WESTMINSTER MD
21157-5637
US

V. Phone/Fax

Practice location:
  • Phone: 410-876-3380
  • Fax: 410-876-5195
Mailing address:
  • Phone: 410-876-3380
  • Fax: 410-876-5195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberD18404
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberD0018404
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: