Provider Demographics
NPI:1225024714
Name:MILLER, SUSAN G (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:G
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:500 HELENDALE RD
Mailing Address - Street 2:SUITE LLE-10
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-3109
Mailing Address - Country:US
Mailing Address - Phone:585-473-7028
Mailing Address - Fax:585-473-0051
Practice Address - Street 1:500 HELENDALE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-3173
Practice Address - Country:US
Practice Address - Phone:585-473-7028
Practice Address - Fax:585-473-0051
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2020-03-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY202372208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01805467Medicaid