MEDICARE: DR. MITCHELL B MILLER MD

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	207Q00000X	Family Medicine Physician	0101032190	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080150542	OTHER	VA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	208896	OTHER	VA	ANTHEM
4	37450	OTHER	VA	OPTIMA

General Provider Information

NPI Number	:	1902809437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MITCHELL B MILLER MD

Provider Business Mailing Address
First Line	:	2109 MCCOMAS WAY
Second Line	:	STE 102
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-3909
Country	:	US
Telephone Number	:	757-563-2800
Fax Number	:	757-563-2300

Provider Business Practice Location Address
First Line	:	2109 MCCOMAS WAY
Second Line	:	STE 102
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-3909
Country	:	US
Telephone Number	:	757-563-2800
Fax Number	:	757-563-2300

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2005
Last Update Date	:	11/30/2007

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