Provider Demographics
NPI:1003082009
Name:DR LESLIE R MILLER PC
Entity Type:Organization
Organization Name:DR LESLIE R MILLER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MEDICAL PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:ROBIN
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:203-256-9905
Mailing Address - Street 1:52 BEACH RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6017
Mailing Address - Country:US
Mailing Address - Phone:203-256-9905
Mailing Address - Fax:203-254-9848
Practice Address - Street 1:52 BEACH RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6017
Practice Address - Country:US
Practice Address - Phone:203-256-9905
Practice Address - Fax:203-254-9848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0000126988506OtherGOLDEN RULE
CT001269885005OtherUNITED HEALTH CARE
CT003988OtherHEALTHNET
CT04000261CT09OtherANTHEM
779677OtherCONNECTCARE
CT736792OtherCIGNA
CTZP476OtherOXFORD
CT4332333OtherAETNA
CT736792OtherCIGNA
CT080001141Medicare PIN