Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | H89171 | MD |
N | 207Q00000X | Family Doctor | OS010455L | PA |
N | 207QA0401X | Family Doctor - Addiction Medicine | OS10455L | PA |
NPI | 1255368130 |
---|---|
Provider Name | Dr. Bradley John Miller |
First Address | Hagerstown, MD 21742-6797 |
Second Address | Hagerstown, MD 21742-6797 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 26/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H13928 | (02) |