Provider Demographics
NPI:1932307535
Name:MILLER, LAUREN DEAN HENNING (DO)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:DEAN HENNING
Last Name:MILLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 HOAGIE DR
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-1884
Mailing Address - Country:US
Mailing Address - Phone:410-893-4844
Mailing Address - Fax:410-893-4927
Practice Address - Street 1:604 HOAGIE DR
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-1884
Practice Address - Country:US
Practice Address - Phone:410-893-4844
Practice Address - Fax:410-893-4927
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH00657932080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH0065793OtherMEDICAL LICENSE