Healthcare Provider Details

I. General information

NPI: 1922102102
Provider Name (Legal Business Name): DONALD E MILLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 01/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 SAYBROOK ROAD
MIDDLETOWN CT
06457
US

IV. Provider business mailing address

540 SAYBROOK ROAD
MIDDLETOWN CT
06457
US

V. Phone/Fax

Practice location:
  • Phone: 860-347-7491
  • Fax: 860-346-2118
Mailing address:
  • Phone: 860-347-7491
  • Fax: 860-346-2118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number012384
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: