Basic Information
| Provider Information | |||||||||
| NPI: | 1053702670 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | EMILY | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26840 POINT LOOKOUT RD | ||||||||
| Address2: | |||||||||
| City: | LEONARDTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206501409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014758091 | ||||||||
| FaxNumber: | 3014756712 | ||||||||
| Practice Location | |||||||||
| Address1: | 26840 POINT LOOKOUT RD | ||||||||
| Address2: | |||||||||
| City: | LEONARDTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206501409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014758091 | ||||||||
| FaxNumber: | 3014756712 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/18/2015 | ||||||||
| LastUpdateDate: | 02/18/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | C0005579 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.