Provider Demographics
NPI:1407058308
Name:MILLER, BENJAMIN J (DO)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:J
Last Name:MILLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 STONER AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-5662
Mailing Address - Country:US
Mailing Address - Phone:410-848-1818
Mailing Address - Fax:410-848-1256
Practice Address - Street 1:295 STONER AVE STE 102
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5662
Practice Address - Country:US
Practice Address - Phone:410-848-1818
Practice Address - Fax:410-848-1256
Is Sole Proprietor?:No
Enumeration Date:2007-06-03
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH70947208000000X, 208600000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program