Provider Demographics
NPI:1093780843
Name:MILLER, LAUREL A (MD)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:A
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 PARK STREET
Mailing Address - Street 2:INFECTIOUS DISEASE CLINICAL SERVICES
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601
Mailing Address - Country:US
Mailing Address - Phone:508-862-5650
Mailing Address - Fax:508-778-4753
Practice Address - Street 1:34 PARK STREET
Practice Address - Street 2:INFECTIOUS DISEASE CLINICAL SERVICES
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601
Practice Address - Country:US
Practice Address - Phone:508-862-5650
Practice Address - Fax:508-778-4753
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA71878207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA40649OtherHPHC
MAJ09088OtherBCBS
J09088Medicare ID - Type Unspecified
E30220Medicare UPIN