Provider Demographics
NPI:1154317642
Name:MILLER, EDWARD MARVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:MARVIN
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5601 LOCH RAVEN BLVD
Mailing Address - Street 2:RUSSELL MORGAN BUILDING 3RD FLOOR
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-2905
Mailing Address - Country:US
Mailing Address - Phone:410-464-5618
Mailing Address - Fax:410-435-5367
Practice Address - Street 1:5601 LOCH RAVEN BLVD
Practice Address - Street 2:RUSSELL MORGAN BUILDING 3RD FLOOR
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-2905
Practice Address - Country:US
Practice Address - Phone:410-464-5618
Practice Address - Fax:410-435-5367
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2010-09-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0019423207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD961731100Medicaid
MD089L554VMedicare ID - Type Unspecified
MD961731100Medicaid