Provider Demographics
NPI:1205927548
Name:MILLER, CAROLYN (RD)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 791372
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-1372
Mailing Address - Country:US
Mailing Address - Phone:301-608-8375
Mailing Address - Fax:301-608-3979
Practice Address - Street 1:1201 SEVEN LOCKS RD
Practice Address - Street 2:SUITE 111
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20854-2931
Practice Address - Country:US
Practice Address - Phone:301-762-5020
Practice Address - Fax:301-762-7235
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX2484133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD415096100Medicaid
MD415096100Medicaid
MD018733R57Medicare PIN