Provider Demographics
NPI:1154324648
Name:MILLER, MARILYN DIANE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:DIANE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:295 STONER AVE
Mailing Address - Street 2:STE 205
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-5637
Mailing Address - Country:US
Mailing Address - Phone:410-876-3380
Mailing Address - Fax:410-876-5195
Practice Address - Street 1:295 STONER AVE
Practice Address - Street 2:STE 205
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5637
Practice Address - Country:US
Practice Address - Phone:410-876-3380
Practice Address - Fax:410-876-5195
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2016-08-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD18404208200000X
MDD0018404208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD77615Medicare UPIN