1528244555 NPI number — ALICE MILLER MD

Table of content: ALICE MILLER MD (NPI 1528244555)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528244555 NPI number — ALICE MILLER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
ALICE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1528244555
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 W FAYETTE ST
Provider Second Line Business Mailing Address:
STE 400
Provider Business Mailing Address City Name:
SYRACUSE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13204-2859
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-472-1488
Provider Business Mailing Address Fax Number:
315-472-8060

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
436 HINSDALE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMILLUS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13031-1648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-488-0996
Provider Business Practice Location Address Fax Number:
315-488-1955
Provider Enumeration Date:
01/22/2008

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: 207Q00000X , with the licence number:  252811 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 252811 . This is a "NY ST LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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