Mill Street Medical Group LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

D0018019 Issued in MD

Legal business name

MILL STREET MEDICAL GROUP LLC

Practice address

340 Mill St
Hagerstown, MD 21740-6138

Phone

(301) 739-7100

Fax

(301) 498-1439

NPI assigned

May 19, 2015

Last updated

Apr 1, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Malena Jean-Smith

Title

Administrator

Phone

(301) 755-9488

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1431993600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459468800000",
    "number": "1134508450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 MILL ST",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217406138",
            "telephone_number": "301-739-7100",
            "fax_number": "301-498-1439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 MILL ST",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217406138",
            "telephone_number": "301-739-7100",
            "fax_number": "301-498-1439"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILL STREET MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-19",
        "last_updated": "2016-04-01",
        "status": "A",
        "authorized_official_last_name": "JEAN-SMITH",
        "authorized_official_first_name": "MALENA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "301-755-9488",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MD",
            "license": "D0018019",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mid-Atlantic Orthopaedic Specialists PC
• Mid-Maryland Medical Transport LLC
• Jill Mikash, CRNP
• Chandace Miley, RN
• Richard S Milford, MD
• Amanda Miller, LGPC
• Amy E Miller
• Blake Miller, PA-S1
• Bradley John Miller, DO
• Brian John Miller, LCSW-C

• Family Medicine Physician in Hagerstown, MD
• Providers in Hagerstown, MD by specialty
• Family Medicine Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.