Provider Demographics
NPI:1093805301
Name:MILLER, SUSAN J (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:ROSE
Other - Last Name:JAFFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6844 TULIP HILL TER
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814
Mailing Address - Country:US
Mailing Address - Phone:301-664-9601
Mailing Address - Fax:301-664-9602
Practice Address - Street 1:8218 WISCONSIN AVE
Practice Address - Street 2:SUITE NUMBER 305
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3107
Practice Address - Country:US
Practice Address - Phone:301-664-9601
Practice Address - Fax:301-664-9602
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-15
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0035579207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE77475Medicare UPIN
554096Medicare ID - Type Unspecified