Provider Demographics
NPI:1407800303
Name:MILLER, LAURENCE CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:LAURENCE
Middle Name:CHARLES
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 1:1055 SAW MILL RIVER RD STE 210
Mailing Address - Street 2:
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502-1046
Mailing Address - Country:US
Mailing Address - Phone:914-494-7921
Mailing Address - Fax:914-231-7667
Practice Address - Street 1:1055 SAW MILL RIVER RD STE 210
Practice Address - Street 2:
Practice Address - City:ARDSLEY
Practice Address - State:NY
Practice Address - Zip Code:10502-1046
Practice Address - Country:US
Practice Address - Phone:914-231-7666
Practice Address - Fax:914-231-7667
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY198911207RC0200X, 207RP1001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01712569Medicaid
NYG42194Medicare UPIN
NY19N212Medicare ID - Type Unspecified