Provider Demographics
NPI:1275547622
Name:MILLER, DAVID M (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:480 LINCOLN AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAUGUS
Mailing Address - State:MA
Mailing Address - Zip Code:01906-3776
Mailing Address - Country:US
Mailing Address - Phone:781-941-2241
Mailing Address - Fax:781-941-2240
Practice Address - Street 1:480 LINCOLN AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:SAUGUS
Practice Address - State:MA
Practice Address - Zip Code:01906-3776
Practice Address - Country:US
Practice Address - Phone:781-941-2241
Practice Address - Fax:781-941-2240
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2017-02-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA204389207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA204389OtherTUFTS HEALTH PLAN
MA0121771Medicaid
MAJ22825OtherBCBS MA
MA204389OtherTUFTS HEALTH PLAN
H34264Medicare UPIN