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General NPI Number Information
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NPI Number | 1144270588
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Entity Type | Individual
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Provider Name | DIANE SWENSEN MILLER M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 04/26/2013
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Provider Practice Location Address
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Address Line | 2457 E. MAIN ST.
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City | WATERBURY
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State | CT
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Zip | 06705
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Country | US
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Telephone | 203-753-8477
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Fax | 203-757-2617
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Provider Business Mailing Address
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Address Line | 2457 E MAIN ST
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City | WATERBURY
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State | CT
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Zip | 06705-2685
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Country | US
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Telephone | 203-753-8477
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Fax | 203-757-2617
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 043014
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License Number State | CT
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