Healthcare Provider Details

I. General information

NPI: 1235136367
Provider Name (Legal Business Name): NORMAN D MILLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 07/03/2023
Certification Date: 07/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 BROWN STREET, SUITE 503
HAVENHILL MA
01830
US

IV. Provider business mailing address

62 BROWN STREET, SUITE 503
HAVENHILL MA
01830
US

V. Phone/Fax

Practice location:
  • Phone: 978-521-3681
  • Fax: 978-521-3682
Mailing address:
  • Phone: 978-521-3681
  • Fax: 978-521-3682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD23142
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number8574
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number55638
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: