Provider Demographics
NPI:1316969520
Name:MILLER, ANGEL JO (CNM)
Entity type:Individual
Prefix:MRS
First Name:ANGEL
Middle Name:JO
Last Name:MILLER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
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Mailing Address - Street 1:26005 RIDGE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DAMASCUS
Mailing Address - State:MD
Mailing Address - Zip Code:20872-1892
Mailing Address - Country:US
Mailing Address - Phone:301-414-2300
Mailing Address - Fax:301-414-2306
Practice Address - Street 1:26005 RIDGE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:DAMASCUS
Practice Address - State:MD
Practice Address - Zip Code:20872-1892
Practice Address - Country:US
Practice Address - Phone:301-414-2300
Practice Address - Fax:301-414-2306
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2014-08-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDR193165367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP-39985Medicare UPIN