Provider Demographics
NPI:1063471126
Name:MILLER, S DAVID (MD)
Entity Type:Individual
Prefix:MR
First Name:S DAVID
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 STATE RD
Mailing Address - Street 2:WATUPPA BUILDING SUITE 203
Mailing Address - City:NORTH DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-3300
Mailing Address - Country:US
Mailing Address - Phone:508-994-0120
Mailing Address - Fax:508-996-9636
Practice Address - Street 1:49 STATE RD
Practice Address - Street 2:WATUPPA BUILDING SUITE 203
Practice Address - City:NORTH DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-3300
Practice Address - Country:US
Practice Address - Phone:508-994-0120
Practice Address - Fax:508-996-9636
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA74380207K00000X, 1744R1102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No1744R1102XOther Service ProvidersSpecialistResearch Study
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3078299Medicaid
E86714Medicare UPIN
MIJ11195Medicare ID - Type Unspecified