Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | 222955 | MN |
Y | 213ER0200X | Radiology | 222955 | MN |
NPI | 1184394116 |
---|---|
Provider Name | Russell Andre Milner |
First Address | Waldorf, MD 20602-1751 |
Second Address | Washington, DC 20019-5509 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2021 |
Last Update Date | 21/09/2021 |