Provider Demographics
NPI:1942669080
Name:MILLER, BONNIE (DVM)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 N GORSUCH RD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-6500
Mailing Address - Country:US
Mailing Address - Phone:443-289-9667
Mailing Address - Fax:443-289-9668
Practice Address - Street 1:418 N GORSUCH RD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6500
Practice Address - Country:US
Practice Address - Phone:443-289-9667
Practice Address - Fax:443-289-9668
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-17
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2590174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian