Basic Information
| Provider Information | |||||||||
| NPI: | 1821399239 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | JUSTIN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7801 OLD BRANCH AVE | ||||||||
| Address2: | STE 300 | ||||||||
| City: | CLINTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207351608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018566718 | ||||||||
| FaxNumber: | 3018566599 | ||||||||
| Practice Location | |||||||||
| Address1: | 8926 WOODYARD RD | ||||||||
| Address2: | STE 301 | ||||||||
| City: | CLINTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207354220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018563670 | ||||||||
| FaxNumber: | 3018680129 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2010 | ||||||||
| LastUpdateDate: | 09/12/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 0102202428 | VA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 174400000X | H0081237 | MD | N | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 922303700 | 05 | MD | MEDICAID | 1821399239 | 05 | VA | MEDICAID |