Provider Demographics
NPI:1417921305
Name:MILLER, JONATHAN (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
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 1:3241 WESTERN BRANCH BLVD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5260
Mailing Address - Country:US
Mailing Address - Phone:757-686-3508
Mailing Address - Fax:757-686-0541
Practice Address - Street 1:6161 KEMPSVILLE CIR
Practice Address - Street 2:SUITE 225
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3932
Practice Address - Country:US
Practice Address - Phone:757-455-6368
Practice Address - Fax:757-455-6686
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101031994207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA268371OtherANTHEM
VA541595397OtherPRIVATE HEALTHCARE SYSTEM
VA22885OtherSENTARA
VA010021456Medicaid
VA541595397OtherAETNA
VA541595397OtherVIRGINIA HEALTH NETWORK
VA541595397OtherCIGNA
VA541595397OtherMID ATLANTIC SOLUTIONS
VAB06267Medicare UPIN
VA010021456Medicaid