Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 033536 | CT |
Y | 111NI0900X | Internist | 033536 | CT |
N | 207RG0300X | Geriatric Medicine | 033536 | CT |
NPI | 1154370401 |
---|---|
Provider Name | Neil Miller |
First Address | Thomaston, CT 06787 |
Second Address | Thomaston, CT 06708 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2006 |
Last Update Date | 28/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001335365 | (05) | CT |
E38241 | (02) | CT |