MEDICARE: DR. MARY SUZANNE MILLER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	200201502	NC
2	207VG0400X	Gynecology Physician	200201502	NC

General Provider Information

NPI Number	:	1467475285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY SUZANNE MILLER MD

Provider Business Mailing Address
First Line	:	1200 N ELM ST
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27401-1004
Country	:	US
Telephone Number	:	336-832-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3518 DRAWBRIDGE PKWY STE 310
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-8432
Country	:	US
Telephone Number	:	336-890-3180
Fax Number	:	336-890-2937

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	01/03/2024

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