Healthcare Provider Details

I. General information

NPI: 1306821814
Provider Name (Legal Business Name): ROBERT WILLIAM MILLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 08/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 SUMMIT CROSSING PL STE 106
GASTONIA NC
28054-2176
US

IV. Provider business mailing address

620 SUMMIT CROSSING PL STE 106
GASTONIA NC
28054-2176
US

V. Phone/Fax

Practice location:
  • Phone: 704-867-8021
  • Fax: 704-864-4606
Mailing address:
  • Phone: 704-867-8021
  • Fax: 704-864-4606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number200101577
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number2001 01577
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: