Provider Demographics
NPI:1073603346
Name:MILLER, HARIATMI KERTONADI (MD)
Entity type:Individual
Prefix:
First Name:HARIATMI
Middle Name:KERTONADI
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9406 BALFOUR DR
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-5721
Mailing Address - Country:US
Mailing Address - Phone:301-530-5752
Mailing Address - Fax:
Practice Address - Street 1:1901 SULPHUR SPRING RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21227-2943
Practice Address - Country:US
Practice Address - Phone:410-536-1410
Practice Address - Fax:410-536-1634
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0035146207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Not Answered207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000155475Medicare ID - Type Unspecified
C87975Medicare UPIN