Provider Demographics
NPI:1922076405
Name:MILLES, GARY ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:ALAN
Last Name:MILLES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8186 LARK BROWN RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6420
Mailing Address - Country:US
Mailing Address - Phone:410-799-8860
Mailing Address - Fax:410-616-8668
Practice Address - Street 1:8186 LARK BROWN RD
Practice Address - Street 2:SUITE 203
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6420
Practice Address - Country:US
Practice Address - Phone:410-799-8860
Practice Address - Fax:410-616-8668
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0026621207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDC49266Medicare UPIN
MD201N205GMedicare PIN