Provider Demographics
NPI:1528371960
Name:MILLER, CHARLES CHRISTIAN (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:CHRISTIAN
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 1:1144 DUBLIN RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-1039
Mailing Address - Country:US
Mailing Address - Phone:614-234-0200
Mailing Address - Fax:614-234-0201
Practice Address - Street 1:1144 DUBLIN RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-1039
Practice Address - Country:US
Practice Address - Phone:614-234-0200
Practice Address - Fax:614-234-0201
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35122095207R00000X
OH35.122095207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0093976Medicaid