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General NPI Number Information
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NPI Number | 1104234319
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Entity Type | Organization
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Legal Business Name | KATINA BYRD MILES, MD LLC
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Dates
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Enumeration Date | 07/31/2014
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Last Update Date | 10/15/2014
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Provider Practice Location Address
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Address Line | 2401 BRANDERMILL BLVD SUITE 240
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City | GAMBRILLS
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State | MD
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Zip | 21054
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Country | US
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Telephone | 410-451-0500
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Fax |
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Provider Business Mailing Address
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Address Line | 2401 BRANDERMILL BLVD SUITE 240
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City | GAMBRILLS
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State | MD
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Zip | 21054-1690
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Country | US
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Telephone | 410-451-0500
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KATINA BRYD MILES
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Credential | M.D.
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Telephone | 410-451-0500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | D0057437
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License Number State | MD
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