Active NPI
Mandy Miller, PA-C
- Physician Assistant
- Owings Mills, MD
National Provider Identifier
1295226504
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- C0002202
- Practice address
- 830 Queens Park Dr
Owings Mills, MD 21117-2250 - Phone
- (443) 474-3803
- NPI assigned
- May 22, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | C0002202 | MD | Primary |
Addresses
Primary practice location
830 Queens Park Dr
Owings Mills, MD 21117-2250
Mailing address
830 Queens Park Dr
Owings Mills, MD 21117-2250
Phone (443) 474-3803
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C0002202 | MD | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1526947200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1526947200000",
"number": "1295226504",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "830 QUEENS PARK DR",
"city": "OWINGS MILLS",
"state": "MD",
"postal_code": "211172250",
"telephone_number": "443-474-3803"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "830 QUEENS PARK DR",
"city": "OWINGS MILLS",
"state": "MD",
"postal_code": "211172250",
"telephone_number": "443-474-3803"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLER",
"first_name": "MANDY",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-05-22",
"last_updated": "2018-05-22",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MD",
"license": "C0002202",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Owings Mills, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.