Provider Demographics
NPI:1821399239
Name:MILLER, TIMOTHY JUSTIN (DO)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JUSTIN
Last Name:MILLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7801 OLD BRANCH AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-1608
Mailing Address - Country:US
Mailing Address - Phone:301-856-6718
Mailing Address - Fax:301-856-6599
Practice Address - Street 1:8926 WOODYARD RD
Practice Address - Street 2:STE 301
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-4220
Practice Address - Country:US
Practice Address - Phone:301-856-3670
Practice Address - Fax:301-868-0129
Is Sole Proprietor?:No
Enumeration Date:2010-11-16
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDH0081237174400000X
ND190962085R0202X
WY15141C2085R0202X
VA01022024282085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD922303700Medicaid
VA1821399239Medicaid
MD518184ZBQOMedicare UPIN
MD922303700Medicaid
VA1821399239Medicaid