Provider Demographics
NPI: | 1437252699 |
---|---|
Name: | MILLER, CARLTON DAVID (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | CARLTON |
Middle Name: | DAVID |
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: | PO BOX 5105 |
Mailing Address - Street 2: | |
Mailing Address - City: | BELFAST |
Mailing Address - State: | ME |
Mailing Address - Zip Code: | 04915-5100 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 919-220-5255 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 4205 BEN FRANKLIN BLVD |
Practice Address - Street 2: | |
Practice Address - City: | DURHAM |
Practice Address - State: | NC |
Practice Address - Zip Code: | 27704-2143 |
Practice Address - Country: | US |
Practice Address - Phone: | 919-477-6900 |
Practice Address - Fax: | 919-477-5081 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-09-06 |
Last Update Date: | 2022-11-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NC | 38485 | 207R00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NC | 8959060 | Medicaid | |
NC | 14012 | Other | BLUE MEDICARE |
NC | P00444627 | Other | RAILROAD MEDICARE |
NC | 59060 | Other | BLUECROSS BLUESHIELD |
NC | P00444627 | Other | RAILROAD MEDICARE |
NC | 2195564F | Medicare PIN | |
NC | 8959060 | Medicaid |