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General NPI Number Information
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NPI Number | 1396915138
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Entity Type | Organization
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Legal Business Name | A. LARRY MILLER, MD LTD
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Dates
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Enumeration Date | 03/07/2008
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Last Update Date | 03/07/2008
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Provider Practice Location Address
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Address Line | 311 MAPLE AVE W SUITE H
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City | VIENNA
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State | VA
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Zip | 22180-4309
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Country | US
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Telephone | 703-938-5660
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Fax |
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Provider Business Mailing Address
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Address Line | 311 MAPLE AVE W SUITE H
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City | VIENNA
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State | VA
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Zip | 22180-4309
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Country | US
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Telephone | 703-938-5660
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. A LARRY MILLER
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Credential | MD
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Telephone | 703-938-5660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 0101026494
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License Number State | VA
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