Provider Demographics
NPI:1023094257
Name:MILLER, SUSAN (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 SECURITY BLVD
Mailing Address - Street 2:MAILSTOP: C1-09-06
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21244-1849
Mailing Address - Country:US
Mailing Address - Phone:410-786-2118
Mailing Address - Fax:
Practice Address - Street 1:7500 SECURITY BLVD
Practice Address - Street 2:MAILSTOP: C1-09-06
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21244-1849
Practice Address - Country:US
Practice Address - Phone:410-786-2118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC19894208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC009700G93Medicare PIN
C02635Medicare UPIN