Provider Demographics
NPI:1710013701
Name:CARLOS A. MILLAN, M.D. P.A.
Entity Type:Organization
Organization Name:CARLOS A. MILLAN, M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRY
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-225-9165
Mailing Address - Street 1:821 N EUTAW ST
Mailing Address - Street 2:105
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-4648
Mailing Address - Country:US
Mailing Address - Phone:410-225-9165
Mailing Address - Fax:410-225-9971
Practice Address - Street 1:821 N EUTAW ST
Practice Address - Street 2:105
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-4648
Practice Address - Country:US
Practice Address - Phone:410-225-9165
Practice Address - Fax:410-225-9971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00161562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDC57567Medicare UPIN