Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | MD034255 | DC |
NPI | 1053460568 |
---|---|
Provider Name | Dr. Katina Byrd Miles |
First Address | Bowie, MD 20716-6314 |
Second Address | Fort Washington, MD 20744-5104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2007 |
Last Update Date | 04/12/2012 |