Most Relevant Information
Provider Data
| NPI Number: | 1003457722 |
| Provider Name: | MARK MILEY PA-C |
| Entity Type: | Individual |
| Taxonomy Code: | 363A00000X |
| Specialty: | Physician Assistant |
| License Number: | C07325 |
Most Important Dates
| Enumeration Date: | 10/03/2019 |
| Last Updated: | 10/03/2019 |
Provider Practice Location
4940 EASTERN AVE
BALTIMORE
MD
212242735
Practice Location Phone/Fax
| Phone: | 4105509227 |
| Fax: |
Provider Mailing Location
3831 ROLAND AVE
BALTIMORE
MD
212112040
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |