# MEDSTAR MEDICAL GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1346514817
- **Authorized official:** EDWARD MILLER M.D. (VICE PRESIDENT)
- **Authorized official phone:** (443) 725-8719

## Contact information

- **Practice address:** 1406 CRAIN HIGHWAY, SUITE 106, GLEN BURNIE, MD 21061-4058
- **Practice address phone:** (410) 768-6440
- **Mailing address:** 8094 SANDPIPER CIR, SUITE O, BALTIMORE, MD 21236-4907
- **Mailing address phone:** (410) 933-3017
- **Mailing address fax:** (410) 933-3019

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/01/2012
- **Last updated:** 03/01/2012