Healthcare Provider Details

I. General information

NPI: 1629461033
Provider Name (Legal Business Name): ALEXANDER MILLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2015
Last Update Date: 07/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 FARMINGTON AVENUE
FARMINGTON CT
06030-8023
US

IV. Provider business mailing address

263 FARMINGTON AVENUE
FARMINGTON CT
06030-8023
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-4477
  • Fax: 860-679-8770
Mailing address:
  • Phone: 860-679-4477
  • Fax: 860-679-8770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number060325
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: