Provider Demographics
NPI:1679611891
Name:MILLER, JACOB DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:DAVID
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WASHINGTON CIR NW
Mailing Address - Street 2:SUITE 405
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-2356
Mailing Address - Country:US
Mailing Address - Phone:202-775-9090
Mailing Address - Fax:202-775-9505
Practice Address - Street 1:3 WASHINGTON CIR NW
Practice Address - Street 2:SUITE 405
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-2356
Practice Address - Country:US
Practice Address - Phone:202-775-9090
Practice Address - Fax:202-775-9505
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC44972084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCAM1294379OtherDEA
DC173610Medicare ID - Type Unspecified
DCC88230Medicare UPIN