Provider Demographics
NPI:1417979865
Name:MILLER, LAWRENCE GORDON III (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:GORDON
Last Name:MILLER
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8002 DISCOVERY DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-8601
Mailing Address - Country:US
Mailing Address - Phone:804-282-2848
Mailing Address - Fax:804-673-3546
Practice Address - Street 1:8002 DISCOVERY DR
Practice Address - Street 2:SUITE 101
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-8601
Practice Address - Country:US
Practice Address - Phone:804-282-2848
Practice Address - Fax:804-673-3546
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101032522173000000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA24848OtherMDIPA
VA006205917Medicaid
VA045806OtherANTHEM BLUECROSS BLUESHIE
VA501270OtherAETNA
VA541421810OtherTAX ID
VA006205917Medicaid
VA045806OtherANTHEM BLUECROSS BLUESHIE