Healthcare Provider Details

I. General information

NPI: 1700930922
Provider Name (Legal Business Name): IRA D MILLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 KINGSLEY LN
NORFOLK VA
23505-4602
US

IV. Provider business mailing address

150 KINGSLEY LN
NORFOLK VA
23505-4602
US

V. Phone/Fax

Practice location:
  • Phone: 757-889-4231
  • Fax: 757-889-4227
Mailing address:
  • Phone: 757-889-4231
  • Fax: 757-889-4227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number0101023350
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: