1851349526 NPI number — LEE ELLIOTT MILLER PT, OCS

Table of content: LEE ELLIOTT MILLER PT, OCS (NPI 1851349526)

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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