Provider Demographics
NPI:1457369852
Name:MILLER, KATHLEEN HAAS (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:HAAS
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 1:800 PRINCE FREDERICK BLVD.
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678
Mailing Address - Country:US
Mailing Address - Phone:410-535-2270
Mailing Address - Fax:410-535-5794
Practice Address - Street 1:800 PRINCE FREDERICK BLVD.
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678
Practice Address - Country:US
Practice Address - Phone:410-535-2270
Practice Address - Fax:410-535-5749
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD25862207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKN35KI66Medicare ID - Type Unspecified
MDKN35KI66Medicare PIN
MDC88969Medicare UPIN