Healthcare Provider Details

I. General information

NPI: 1225024714
Provider Name (Legal Business Name): SUSAN G MILLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 03/11/2020
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 HELENDALE RD SUITE 200
ROCHESTER NY
14609-3173
US

IV. Provider business mailing address

500 HELENDALE RD SUITE LLE-10
ROCHESTER NY
14609-3109
US

V. Phone/Fax

Practice location:
  • Phone: 585-473-7028
  • Fax: 585-473-0051
Mailing address:
  • Phone: 585-473-7028
  • Fax: 585-473-0051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number202372
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: