Provider Demographics
NPI:1841240470
Name:MILLER, STANLEY JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:JOSEPH
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 KENILWORTH DR
Mailing Address - Street 2:STE 201
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2101
Mailing Address - Country:US
Mailing Address - Phone:443-279-0340
Mailing Address - Fax:
Practice Address - Street 1:1104 KENILWORTH DR
Practice Address - Street 2:STE 201
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2101
Practice Address - Country:US
Practice Address - Phone:443-279-0340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD41550207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE98127Medicare UPIN
MDH766JOMedicare ID - Type UnspecifiedGROUP
MDHN69Medicare ID - Type UnspecifiedINDIVIDUAL
MDS823JOMedicare ID - Type UnspecifiedGROUP
MD253MMedicare ID - Type UnspecifiedINDIVIDUAL