Provider Demographics
NPI:1104971407
Name:MILLER, ABBIE MAE BUCK (MD)
Entity type:Individual
Prefix:
First Name:ABBIE MAE
Middle Name:BUCK
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ABBIE MAE
Other - Middle Name:B
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:110 IRVING ST NW
Mailing Address - Street 2:SUITE 1A-50
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-3017
Mailing Address - Country:US
Mailing Address - Phone:202-877-2835
Mailing Address - Fax:202-877-8288
Practice Address - Street 1:1500 GALEN ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-4913
Practice Address - Country:US
Practice Address - Phone:202-877-2835
Practice Address - Fax:202-877-8288
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101238313207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD027428500Medicaid
DC089330300Medicaid
VA1104971407Medicaid