Provider Demographics
NPI:1770986861
Name:MILAM, ANNE FETCHER (PA)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:FETCHER
Last Name:MILAM
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:FETCHER
Other - Last Name:MILAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:10215 FERNWOOD RD
Mailing Address - Street 2:STE 100
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1183
Mailing Address - Country:US
Mailing Address - Phone:301-493-4440
Mailing Address - Fax:301-493-9778
Practice Address - Street 1:10215 FERNWOOD RD STE 100
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1183
Practice Address - Country:US
Practice Address - Phone:301-493-4440
Practice Address - Fax:301-493-9778
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-02
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC06162363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant