Provider Demographics
NPI:1356507792
Name:STEPHEN A. MILLER, M.D.,PC
Entity Type:Organization
Organization Name:STEPHEN A. MILLER, M.D.,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-481-3179
Mailing Address - Street 1:1729 WILDWOOD DRIVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3176
Mailing Address - Country:US
Mailing Address - Phone:757-481-3179
Mailing Address - Fax:757-481-5294
Practice Address - Street 1:1729 WILDWOOD DRIVE
Practice Address - Street 2:SUITE 103
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3176
Practice Address - Country:US
Practice Address - Phone:757-481-3179
Practice Address - Fax:757-481-5294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101034633174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty