Provider Demographics
NPI:1851352074
Name:MILLER, BARRY WILLIAM (CRNP)
Entity Type:Individual
Prefix:MR
First Name:BARRY
Middle Name:WILLIAM
Last Name:MILLER
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10903 NEW HAMPSHIRE AVE
Mailing Address - Street 2:WO 22-2114
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-1058
Mailing Address - Country:US
Mailing Address - Phone:240-402-3195
Mailing Address - Fax:
Practice Address - Street 1:10 CENTER DR
Practice Address - Street 2:ROOM 6N106
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-0001
Practice Address - Country:US
Practice Address - Phone:301-435-4627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007774363LF0000X
MDR176141363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAQ10911Medicare UPIN
MD140998ZAWGMedicare PIN
PA077353ER6Medicare ID - Type Unspecified
PASP007774OtherCRNP STATE LICENSE