Provider Demographics
NPI:1194829366
Name:MILLER, ERIC BRADLEY (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:BRADLEY
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 1:58 ALBERT AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02905-3810
Mailing Address - Country:US
Mailing Address - Phone:401-435-6600
Mailing Address - Fax:
Practice Address - Street 1:450 VETERANS MEMORIAL PKWY
Practice Address - Street 2:BUILDING 14
Practice Address - City:E PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-5300
Practice Address - Country:US
Practice Address - Phone:401-435-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD08216208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI20354OtherBLUE SHIELD
RI9020122Medicaid
RI20354OtherBLUE SHIELD
RI349020354Medicare ID - Type Unspecified
RIF34108Medicare UPIN