Provider Demographics
NPI:1053460568
Name:MILES, KATINA BYRD (MD)
Entity Type:Individual
Prefix:DR
First Name:KATINA
Middle Name:BYRD
Last Name:MILES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16112 EDENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-6314
Mailing Address - Country:US
Mailing Address - Phone:301-352-7677
Mailing Address - Fax:
Practice Address - Street 1:11701 LIVINGSTON RD
Practice Address - Street 2:SUITE 302
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-5104
Practice Address - Country:US
Practice Address - Phone:301-292-6010
Practice Address - Fax:301-203-1838
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD034255207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology