Healthcare Provider Details

I. General information

NPI: 1497720312
Provider Name (Legal Business Name): RICHARD G MILLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 GRAY ROCK LN
CHAPPAQUA NY
10514-2511
US

IV. Provider business mailing address

20 GRAY ROCK LN
CHAPPAQUA NY
10514-2511
US

V. Phone/Fax

Practice location:
  • Phone: 914-238-3958
  • Fax: 914-238-3958
Mailing address:
  • Phone: 914-238-3958
  • Fax: 914-238-3958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMA058602
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number136250
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number035477
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: