Provider Demographics
NPI:1912078064
Name:MILLWATER, JOHN ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROBERT
Last Name:MILLWATER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5454 WISCONSIN AVE STE 950
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-6912
Mailing Address - Country:US
Mailing Address - Phone:301-657-5700
Mailing Address - Fax:301-654-9132
Practice Address - Street 1:5454 WISCONSIN AVE STE 950
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-6912
Practice Address - Country:US
Practice Address - Phone:301-657-5700
Practice Address - Fax:301-654-9132
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-12
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD4291207W00000X
MDD0016476207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC177978Medicare PIN
B94231Medicare UPIN