Provider Demographics
NPI:1518754027
Name:MILLER, BLAKE (PA-S1)
Entity type:Individual
Prefix:
First Name:BLAKE
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:PA-S1
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 185
Mailing Address - Street 2:
Mailing Address - City:CORRIGANVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21524-0185
Mailing Address - Country:US
Mailing Address - Phone:301-697-4599
Mailing Address - Fax:
Practice Address - Street 1:32 W WASHINGTON ST # 403
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-4884
Practice Address - Country:US
Practice Address - Phone:240-527-2752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant