Provider Demographics
NPI:1104234319
Name:KATINA BYRD MILES, MD LLC
Entity type:Organization
Organization Name:KATINA BYRD MILES, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATINA
Authorized Official - Middle Name:BRYD
Authorized Official - Last Name:MILES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-451-0500
Mailing Address - Street 1:2401 BRANDERMILL BLVD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-1690
Mailing Address - Country:US
Mailing Address - Phone:410-451-0500
Mailing Address - Fax:
Practice Address - Street 1:2401 BRANDERMILL BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054
Practice Address - Country:US
Practice Address - Phone:410-451-0500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-31
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0057437207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty