1134104771 NPI number — CHARLES D MILLER OD

Table of content: CHARLES D MILLER OD (NPI 1134104771)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134104771 NPI number — CHARLES D MILLER OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
CHARLES
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
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:
1134104771
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2616 LAWNDALE DR
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27408-4800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-288-1919
Provider Business Mailing Address Fax Number:
336-545-1931

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2616 LAWNDALE DR
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27408-4800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-288-1919
Provider Business Practice Location Address Fax Number:
336-545-1931
Provider Enumeration Date:
12/07/2005

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: 152W00000X , with the licence number:  1035 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 22027058 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 21944 . This is a "PARTNERS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 73917 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 093F2 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 6271257 . This is a "CIGNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 0327310001 . This is a "DMERC SUPPLIER NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 89093F2 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 410047496 . This is a "RAILROAD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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