Provider Demographics
NPI:1376549402
Name:MILLER, FREDERICK S (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:S
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 1:15 LOWELL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2748
Mailing Address - Country:US
Mailing Address - Phone:207-774-8277
Mailing Address - Fax:207-871-1415
Practice Address - Street 1:15 LOWELL ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2748
Practice Address - Country:US
Practice Address - Phone:207-774-8277
Practice Address - Fax:207-871-1415
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME012214207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME289340099Medicaid
MEMM2530Medicare ID - Type Unspecified
ME289340099Medicaid