Provider Demographics
NPI:1891868113
Name:HILLER, CARMEN ROCIO (MD)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:ROCIO
Last Name:HILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CARMEN
Other - Middle Name:
Other - Last Name:HILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:9910 FRANKLIN SQUARE DR # 2110
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4902
Mailing Address - Country:US
Mailing Address - Phone:410-933-5412
Mailing Address - Fax:410-933-1390
Practice Address - Street 1:137 MITCHELLS CHANCE RD
Practice Address - Street 2:SUITE 180
Practice Address - City:EDGEWATER
Practice Address - State:MD
Practice Address - Zip Code:21037
Practice Address - Country:US
Practice Address - Phone:410-224-8220
Practice Address - Fax:410-841-2482
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0071757207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD335001100Medicaid
MD97605201OtherCAREFIRST BCBS OF MARYLAND
MD8446236OtherAETNA HMO
MD252879OtherEHP/PRIORITY PARTNERS
MD0119OtherCAREFIRST BCBS BLUECHOICE
MDP19946OtherCAREFIRST BCBS POS
MD4294799OtherAETNA PPO
MD97605201OtherCAREFIRST BCBS OF MARYLAND