Provider Demographics
NPI:1528201969
Name:MILLER, JACQUELINE JOY (MD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:JOY
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 RED MAPLE CT
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-1433
Mailing Address - Country:US
Mailing Address - Phone:410-356-1615
Mailing Address - Fax:410-356-1615
Practice Address - Street 1:13 RED MAPLE CT
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-1433
Practice Address - Country:US
Practice Address - Phone:410-356-1615
Practice Address - Fax:410-356-1615
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD44901208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF10964Medicare UPIN