Provider Demographics
NPI:1003831728
Name:MILLER, LARRY R (CRNA)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:R
Last Name:MILLER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 COURT ST
Mailing Address - Street 2:DEPT OF ANESTHESIOLOGY
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431
Mailing Address - Country:US
Mailing Address - Phone:603-354-5454
Mailing Address - Fax:603-354-5419
Practice Address - Street 1:580 COURT ST
Practice Address - Street 2:DEPT OF ANESTHESIOLOGY
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431
Practice Address - Country:US
Practice Address - Phone:603-354-5454
Practice Address - Fax:603-354-5419
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH017999-23-11207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D63835Medicare UPIN
NT0029Medicare ID - Type Unspecified