Provider Demographics
NPI:1053702670
Name:MILLER, EMILY MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26840 POINT LOOKOUT RD
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-1409
Mailing Address - Country:US
Mailing Address - Phone:301-475-8091
Mailing Address - Fax:301-475-6712
Practice Address - Street 1:26840 POINT LOOKOUT RD
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-1409
Practice Address - Country:US
Practice Address - Phone:301-475-8091
Practice Address - Fax:301-475-6712
Is Sole Proprietor?:No
Enumeration Date:2015-02-18
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDC0005579363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical