Provider Demographics
NPI:1609947324
Name:MILLER, M. KIRSTEN (MD)
Entity Type:Individual
Prefix:DR
First Name:M. KIRSTEN
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:KIRSTEN
Other - Last Name:BRADSTOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1520 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2623
Mailing Address - Country:US
Mailing Address - Phone:803-799-8407
Mailing Address - Fax:803-635-2833
Practice Address - Street 1:1520 LAUREL ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2623
Practice Address - Country:US
Practice Address - Phone:803-799-8407
Practice Address - Fax:803-635-2833
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1667952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF95048Medicare UPIN