1851349526 NPI number — LEE ELLIOTT MILLER PT, OCS

Table of content: CHRISTIAN HAACK (NPI 1538722780)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851349526 NPI number — LEE ELLIOTT MILLER PT, OCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
LEE
Provider Middle Name:
ELLIOTT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT, OCS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851349526
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 E ROLLING XRDS STE 57
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CATONSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21228-6212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-860-9168
Provider Business Mailing Address Fax Number:
443-636-5987

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 CROSSROADS DR STE 13
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OWINGS MILLS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21117-5479
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-363-0015
Provider Business Practice Location Address Fax Number:
410-356-7763
Provider Enumeration Date:
05/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  14756 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: LV17 . This is a "CAREFIRST BLUECROSS/SHIEL" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 373628800 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: E705-0001 . This is a "FEDERAL BLUECROSS/SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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