Provider Demographics
NPI:1528027430
Name:MILLER, GARY (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:
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 1:100 N MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:CT
Mailing Address - Zip Code:06019-2140
Mailing Address - Country:US
Mailing Address - Phone:860-558-3662
Mailing Address - Fax:860-693-0888
Practice Address - Street 1:100 N MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:CT
Practice Address - Zip Code:06019-2140
Practice Address - Country:US
Practice Address - Phone:860-558-3662
Practice Address - Fax:860-693-0888
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT025717207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110233167OtherRAILROAD MEDICARE
0442003OtherUNITED H C
0V8223OtherHEALTHNET
2469391OtherAETNA
P44182552OtherMULTIPLAN
CT001257171Medicaid
01025717OtherCIGNA
061606960OtherPHCS
010025717CT01OtherBCBS
061606960OtherTRICARE
705992OtherCT CARE
0407238OtherEVERCARE
135723OtherWELLCARE
HAP017OtherOXFORD
HAP017OtherOXFORD
705992OtherCT CARE
E41717Medicare UPIN