Provider Demographics
NPI:1851903512
Name:MILBURN, TEAIRA GENEVA
Entity Type:Individual
Prefix:
First Name:TEAIRA
Middle Name:GENEVA
Last Name:MILBURN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3828 LAKEWOOD PL
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-1429
Mailing Address - Country:US
Mailing Address - Phone:124-092-5944
Mailing Address - Fax:240-607-7229
Practice Address - Street 1:3828 LAKEWOOD PL
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-1429
Practice Address - Country:US
Practice Address - Phone:240-925-9449
Practice Address - Fax:240-607-7229
Is Sole Proprietor?:No
Enumeration Date:2020-08-23
Last Update Date:2020-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy