Provider Demographics
NPI:1093825549
Name:MILLER, SUSAN W (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:W
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 1:140 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-1715
Mailing Address - Country:US
Mailing Address - Phone:304-842-2206
Mailing Address - Fax:
Practice Address - Street 1:140 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-1715
Practice Address - Country:US
Practice Address - Phone:304-842-2206
Practice Address - Fax:304-842-2580
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV13068207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine