1528027430 NPI number — DR. GARY MILLER MD

Table of content: DR. GARY MILLER MD (NPI 1528027430)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528027430 NPI number — DR. GARY MILLER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
GARY
Provider Middle Name:
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:
1528027430
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 N MOUNTAIN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANTON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06019-2140
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-558-3662
Provider Business Mailing Address Fax Number:
860-693-0888

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 N MOUNTAIN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06019-2140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-558-3662
Provider Business Practice Location Address Fax Number:
860-693-0888
Provider Enumeration Date:
03/20/2006

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:  025717 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 110233167 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0442003 . This is a "UNITED H C" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0V8223 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2469391 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P44182552 . This is a "MULTIPLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001257171 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01025717 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 061606960 . This is a "PHCS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010025717CT01 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 061606960 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 705992 . This is a "CT CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0407238 . This is a "EVERCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 135723 . This is a "WELLCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: HAP017 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".




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