Provider Demographics
NPI:1417999293
Name:MILLER, DAVID H (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:H
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 1:2150 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104
Mailing Address - Country:US
Mailing Address - Phone:413-739-5676
Mailing Address - Fax:413-739-2278
Practice Address - Street 1:2150 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-3300
Practice Address - Country:US
Practice Address - Phone:413-739-5676
Practice Address - Fax:413-739-2278
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA42855207RR0500X
CT029655207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010042855MA01OtherBLUE CROSS BLUE SHIELD
MAN51700OtherBLUE CROSS BLUE SHIELD
MA2063026Medicaid
CT010029655CT01OtherBLUE CROSS BLUE SHIELD
MA042855OtherTUFTS HEALTH PLAN
MA14471OtherHEALTH NEW ENGLAND
CT010029655CT01OtherBLUE CROSS BLUE SHIELD
MAN51700OtherBLUE CROSS BLUE SHIELD