Individual
KELLY L MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1417 MADISON PARK DRIVE, GLEN BURNIE, MD 21061
(410) 768-6600
(410) 553-0710
Mailing address
1417 MADISON PARK DRIVE, GLEN BURNIE, MD 21061
(410) 768-6600
(410) 553-0710
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
D61418
MD
207RI0011X
Interventional Cardiology Physician
Primary
D61418
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004362100
—
MD
01
—
P00434480
MEDICARE RAILROAD
MD
Enumeration date
03/30/2006
Last updated
03/19/2012
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