Provider Demographics
NPI:1346324365
Name:CHILDRESS, MILTON D (MD)
Entity Type:Individual
Prefix:
First Name:MILTON
Middle Name:D
Last Name:CHILDRESS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:20 TREMONT ST
Mailing Address - Street 2:#20
Mailing Address - City:DUXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02332-5310
Mailing Address - Country:US
Mailing Address - Phone:781-934-9741
Mailing Address - Fax:
Practice Address - Street 1:20 TREMONT ST
Practice Address - Street 2:#20
Practice Address - City:DUXBURY
Practice Address - State:MA
Practice Address - Zip Code:02332-5310
Practice Address - Country:US
Practice Address - Phone:781-934-9741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2126332084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology