Provider Demographics
NPI:1487642070
Name:MILLER, MARY LYNN (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LYNN
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5 PATRICK HENRY CIR
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-2134
Mailing Address - Country:US
Mailing Address - Phone:978-263-1909
Mailing Address - Fax:
Practice Address - Street 1:20 COMMERCIAL RD
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-3306
Practice Address - Country:US
Practice Address - Phone:978-435-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA40168207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0801700OtherUNITED HEALTH CARE
MAAA30748OtherHARVARDPILGRIM
MA9900841OtherFALLON COMMUNITY HEALTH P
MA3748795OtherAETNA HEALTH INSURANCE PR
MA6195474Medicaid
MA717866OtherTUFTS HEALTH PLAN
MAB30168OtherBLUE CROSS BLUE SHIELD
MA0801700OtherUNITED HEALTH CARE
MA6195474Medicaid