Healthcare Provider Details

I. General information

NPI: 1467573147
Provider Name (Legal Business Name): MATTHEW C MILLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 07/06/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2365 S CLINTON AVE SUITE 200
ROCHESTER NY
14618-2663
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 629
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-758-5700
  • Fax: 585-758-1293
Mailing address:
  • Phone: 585-758-5700
  • Fax: 585-758-1293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number253035
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number253035
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: