Healthcare Provider Details

I. General information

NPI: 1982994976
Provider Name (Legal Business Name): MARLAINE JEAN-MILLER M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2011
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 RETREAT AVE STE 201
HARTFORD CT
06106-2528
US

IV. Provider business mailing address

100 RETREAT AVE SUITE 201
HARTFORD CT
06106-2528
US

V. Phone/Fax

Practice location:
  • Phone: 860-246-8568
  • Fax: 860-493-7798
Mailing address:
  • Phone: 860-246-8568
  • Fax: 860-493-7798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number053796
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: