Provider Demographics
NPI:1083613004
Name:MILLER, WENDY LEIGH (MD)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:LEIGH
Last Name:MILLER
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:PO BOX 900
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21158-0900
Mailing Address - Country:US
Mailing Address - Phone:410-871-6502
Mailing Address - Fax:
Practice Address - Street 1:605 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-2503
Practice Address - Country:US
Practice Address - Phone:803-358-6100
Practice Address - Fax:803-358-6105
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0072229207Q00000X
SC25928207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC259286Medicaid
MD552305200Medicaid
MD216161YBDBMedicare PIN