Provider Demographics
NPI:1003218330
Name:MILLER, GEORGE H
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:H
Last Name:MILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:NY
Mailing Address - Zip Code:12972-2616
Mailing Address - Country:US
Mailing Address - Phone:518-643-6000
Mailing Address - Fax:518-643-6212
Practice Address - Street 1:17 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:NY
Practice Address - Zip Code:12972-2616
Practice Address - Country:US
Practice Address - Phone:518-643-6000
Practice Address - Fax:518-643-6212
Is Sole Proprietor?:No
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY320632163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool