Provider Demographics
NPI:1992916936
Name:MILLER, JENA LYN (MD)
Entity type:Individual
Prefix:DR
First Name:JENA
Middle Name:LYN
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 1:600 N WOLFE ST
Mailing Address - Street 2:NELSON 228
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287-0005
Mailing Address - Country:US
Mailing Address - Phone:443-287-9480
Mailing Address - Fax:410-614-1617
Practice Address - Street 1:600 N WOLFE ST
Practice Address - Street 2:NELSON 228
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0005
Practice Address - Country:US
Practice Address - Phone:443-287-9480
Practice Address - Fax:410-614-1617
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101247584207VM0101X
MDD65575207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA411596OtherANTHEM
VAPAROtherCORVEL
VAPAROtherUSA MANAGED CARE
VA1992916936OtherUNITED HEALTHCARE
VAPAROtherAETNA
VA1992916936Medicaid
VIPAROtherCIGNA
VA-010OtherTRICARE/CHAMPUS
VAPAROtherVIRGINIA HEALTH NETWORK
VA1992916936OtherCOVENTRY NETWORK
VA1992916936OtherVIRGINIA PREMIER HEALTH PLAN
VA10063694OtherOPTIMA HEALTH
NC1992916936Medicaid
VAPAROtherMULTIPLAN
VAPAROtherAETNA