MEDICARE: DR. ELIZABETH A. MILLER DO

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	2080A0000X	Pediatric Adolescent Medicine Physician	2007-01057	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	J10752	OTHER	MA	BC/BS OF MA
2	082065	OTHER	MA	TUFTS HEALTH PLAN

General Provider Information

NPI Number	:	1790899060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH A. MILLER DO

Provider Business Mailing Address
First Line	:	3725 MANORBROOK RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27607-6009
Country	:	US
Telephone Number	:	919-617-8521
Fax Number	:

Provider Business Practice Location Address
First Line	:	1156 HIGH ST
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95064-1099
Country	:	US
Telephone Number	:	831-459-1740
Fax Number	:	831-459-1740

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

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	08/16/2019

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