Individual ProviderMamta M MilesNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address3600 Joseph Siewick Dr, Fairfax, VA 22033-1709(703) 391-3129(703) 295-9360PECOS EnrollmentBased on the most recent information from CMS, provider Mamta M Miles does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 9:15 AM.Profile DetailsProvider ID1396903878Provider TypeIndividualFull NameMiles, Mamta MGenderFemaleSole ProprietorNoEnumeration Date5/30/2008Last Updated9/14/2011Contact InformationPractice LocationPractice Address3600 Joseph Siewick Dr, Fairfax, VA 22033-1709Phone(703) 391-3129FaxUnlisted FaxMailing LocationMailing AddressPO Box 37090, Baltimore, MD 21297-3090Phone(703) 295-9360Fax(703) 295-9369Provider TaxonomiesCodeDescriptionLicenseCode367500000XPrimaryDescriptionNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing ProvidersLicenseRN1006629District of ColumbiaProvider IdentifiersIDDescriptionIssuerID6236DescriptionOtherIssuerKAISERVirginiaIDK-142-0002DescriptionOtherIssuerCARE FIRSTVirginia