Provider Demographics
NPI:1487689170
Name:MINER, CHARLES III (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:MINER
Suffix:III
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 1:1500 POST RD
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-5935
Mailing Address - Country:US
Mailing Address - Phone:203-276-4801
Mailing Address - Fax:203-276-4808
Practice Address - Street 1:1500 POST RD
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-5935
Practice Address - Country:US
Practice Address - Phone:203-276-4801
Practice Address - Fax:203-276-4808
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT23606207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001236066Medicaid
CT110218045OtherRAILROAD MEDICARE
CT001236066Medicaid
CT110001470Medicare ID - Type Unspecified