Provider Demographics
NPI:1073574661
Name:MILLER, LINCOLN (MD)
Entity Type:Individual
Prefix:DR
First Name:LINCOLN
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:PO BOX 1268
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940-8268
Mailing Address - Country:US
Mailing Address - Phone:973-966-6400
Mailing Address - Fax:973-514-1587
Practice Address - Street 1:1500 PLEASANT VALLEY WAY
Practice Address - Street 2:SUITE 201
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-2956
Practice Address - Country:US
Practice Address - Phone:973-966-6400
Practice Address - Fax:973-514-1587
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06528400207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7230800Medicaid
NJ740757X70Medicare PIN
NJ7230800Medicaid