MEDICARE: A. LARRY MILLER, MD LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2500X	Medical Specialty Clinic/Center	0101026494	VA

General Provider Information

NPI Number	:	1396915138
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A. LARRY MILLER, MD LTD

Provider Business Mailing Address
First Line	:	311 MAPLE AVE W
Second Line	:	SUITE H
City	:	VIENNA
State	:	VA
Zip	:	22180-4309
Country	:	US
Telephone Number	:	703-938-5660
Fax Number	:

Provider Business Practice Location Address
First Line	:	311 MAPLE AVE W
Second Line	:	SUITE H
City	:	VIENNA
State	:	VA
Zip	:	22180-4309
Country	:	US
Telephone Number	:	703-938-5660
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. A LARRY MILLER
Credential	:	MD
Telephone Number	:	703-938-5660

Provider Enumeration Date	:	03/07/2008
Last Update Date	:	03/07/2008

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