Provider Demographics
NPI:1992401251
Name:GALVAN LAM, MILTON ABRAHAM (CRNP)
Entity type:Individual
Prefix:
First Name:MILTON
Middle Name:ABRAHAM
Last Name:GALVAN LAM
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 CLOVER CIR
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-3244
Mailing Address - Country:US
Mailing Address - Phone:240-300-2783
Mailing Address - Fax:
Practice Address - Street 1:3600 LEONARDTOWN RD STE 101
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-3647
Practice Address - Country:US
Practice Address - Phone:301-645-5951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR226692363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily