Healthcare Provider Details

I. General information

NPI: 1154370401
Provider Name (Legal Business Name): NEIL MILLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2006
Last Update Date: 10/28/2021
Certification Date: 10/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CHASE PARKWAY 3RD FL
THOMASTON CT
06708
US

IV. Provider business mailing address

500 CHASE PARKWAY 3RD FL
THOMASTON CT
06787
US

V. Phone/Fax

Practice location:
  • Phone: 203-574-2930
  • Fax: 203-574-2933
Mailing address:
  • Phone: 203-574-2930
  • Fax: 203-574-2933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number033536
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number033536
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: