Healthcare Provider Details

I. General information

NPI: 1699824078
Provider Name (Legal Business Name): GARY ARTHUR MILLER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 COLUMBUS BLVD
HARTFORD CT
06103-1801
US

IV. Provider business mailing address

450 COLUMBUS BLVD
HARTFORD CT
06103-1801
US

V. Phone/Fax

Practice location:
  • Phone: 800-960-9780
  • Fax: 860-702-9446
Mailing address:
  • Phone: 800-960-9780
  • Fax: 860-702-9446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number001145
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: