Provider Demographics
NPI:1770011801
Name:MILLER, ELIE NAHUM (MD)
Entity type:Individual
Prefix:DR
First Name:ELIE
Middle Name:NAHUM
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6513 DEANCROFT RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-2722
Mailing Address - Country:US
Mailing Address - Phone:617-990-4197
Mailing Address - Fax:
Practice Address - Street 1:1 RESERVOIR CIR STE 200
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-6413
Practice Address - Country:US
Practice Address - Phone:443-242-7265
Practice Address - Fax:410-397-1659
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-02
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0087909207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine