Provider Demographics
NPI:1225241359
Name:MILLER, LESLIE ROBIN (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:ROBIN
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 BEACH RD
Mailing Address - Street 2:STE 102
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6017
Mailing Address - Country:US
Mailing Address - Phone:203-256-9905
Mailing Address - Fax:203-254-9848
Practice Address - Street 1:52 BEACH RD
Practice Address - Street 2:STE 102
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6017
Practice Address - Country:US
Practice Address - Phone:203-256-9905
Practice Address - Fax:203-254-9848
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000261207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT040000261CT09OtherANTHEM BLUE CROSS
CT000261OtherCT LICENSE
CT040000261CT09OtherANTHEM BLUE CROSS