Healthcare Provider Details

I. General information

NPI: 1417979865
Provider Name (Legal Business Name): LAWRENCE GORDON MILLER III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 10/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8002 DISCOVERY DR SUITE 101
RICHMOND VA
23229-8601
US

IV. Provider business mailing address

8002 DISCOVERY DR SUITE 101
RICHMOND VA
23229-8601
US

V. Phone/Fax

Practice location:
  • Phone: 804-282-2848
  • Fax: 804-673-3546
Mailing address:
  • Phone: 804-282-2848
  • Fax: 804-673-3546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number0101032522
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101032522
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: