Provider Demographics
NPI:1053349902
Name:MILLER, VENERA R (MD)
Entity type:Individual
Prefix:DR
First Name:VENERA
Middle Name:R
Last Name:MILLER
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-0022
Mailing Address - Country:US
Mailing Address - Phone:410-535-6520
Mailing Address - Fax:410-535-6523
Practice Address - Street 1:242 MERRIMAC COURT
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-0022
Practice Address - Country:US
Practice Address - Phone:410-535-6520
Practice Address - Fax:410-535-6523
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00626582083A0300X, 2084P0800X
VA01012763462084P0800X
DCMD0356172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4096525 00Medicaid
MDI31527Medicare UPIN
MD463SMedicare ID - Type Unspecified