Provider Demographics
NPI:1144361544
Name:DILLER, MILES (PHD)
Entity type:Individual
Prefix:DR
First Name:MILES
Middle Name:
Last Name:DILLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2924
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-2984
Mailing Address - Country:US
Mailing Address - Phone:301-609-9887
Mailing Address - Fax:301-609-9091
Practice Address - Street 1:489 MAIN ST
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-3187
Practice Address - Country:US
Practice Address - Phone:410-535-3947
Practice Address - Fax:301-609-9091
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM723103TC0700X
NM267420103TS0200X
MD02457103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMZ4787Medicaid