Provider Demographics
NPI:1205174430
Name:LUIS LAM, MILAY (MD)
Entity type:Individual
Prefix:
First Name:MILAY
Middle Name:
Last Name:LUIS LAM
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 1:11116 MEDICAL CAMPUS RD
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-6710
Mailing Address - Country:US
Mailing Address - Phone:301-714-4041
Mailing Address - Fax:
Practice Address - Street 1:11110 MEDICAL CAMPUS RD STE 108
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-6734
Practice Address - Country:US
Practice Address - Phone:301-714-4041
Practice Address - Fax:301-714-4351
Is Sole Proprietor?:No
Enumeration Date:2013-01-23
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD466244174400000X
NY281525207R00000X, 207RE0101X
MDD90409207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No174400000XOther Service ProvidersSpecialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY698866OtherMMIS
NY308544OtherNBHN