1124094883 NPI number — DR. EDWARD C MILLER MD

Table of content: DR. EDWARD C MILLER MD (NPI 1124094883)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124094883 NPI number — DR. EDWARD C MILLER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
EDWARD
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124094883
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 MEDICAL PKWY STE 120
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHESAPEAKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23320-4985
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-252-5660
Provider Business Mailing Address Fax Number:
757-548-9443

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 MEDICAL PKWY STE 120
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHESAPEAKE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23320-4985
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-252-5660
Provider Business Practice Location Address Fax Number:
757-548-9443
Provider Enumeration Date:
02/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  0101032556 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 0101032556 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0011X , with the licence number: 0101032556 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: -001 . This is a "CHAMPUS/TRICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 250365 . This is a "ATHEM BC/BS VA/HK" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 263654 . This is a "UHC/MAMSI/MDIPA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 890582M , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: PAR . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: PAR . This is a "FIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 006013236 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 006053335 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110130157 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 15070 . This is a "OPTIMA/SENTARA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: PAR . This is a "VIRGINIA PREMIER HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: PAR . This is a "MULTIPLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0582M . This is a "BC/BS NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: PAR . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: PAR . This is a "CORVEL/CORCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: PAR . This is a "VIRGINIA HEALTH NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 15792 . This is a "SENTARA OHP/SHP" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 259542 . This is a "ANTHEM BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: PAR . This is a "USA MANAGED CARE" identifier . This identifiers is of the category "OTHER".




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