Provider Demographics
NPI:1083727663
Name:MILLER, NOAH L (MD)
Entity Type:Individual
Prefix:
First Name:NOAH
Middle Name:L
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 1:29425 CHAGRIN BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PEPPER PIKE
Mailing Address - State:OH
Mailing Address - Zip Code:44122
Mailing Address - Country:US
Mailing Address - Phone:216-292-0610
Mailing Address - Fax:216-292-0627
Practice Address - Street 1:29425 CHAGRIN BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:PEPPER PIKE
Practice Address - State:OH
Practice Address - Zip Code:44122
Practice Address - Country:US
Practice Address - Phone:216-292-0610
Practice Address - Fax:216-292-0627
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350838702084P0804X
OH35-0838702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000224434OtherUNISON
OH7987832OtherAETNA
OH363846OtherWELLCARE MEDICAID
OH2590174Medicaid
OH000000532999OtherANTHEM
OHMI4161702Medicare PIN
OHMI4161703Medicare PIN
OH000000532999OtherANTHEM