Provider Demographics
NPI:1568927101
Name:MILLER, VIRGINIA ELLEN (PA)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:ELLEN
Last Name:MILLER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 WILLOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-2062
Mailing Address - Country:US
Mailing Address - Phone:336-601-7022
Mailing Address - Fax:
Practice Address - Street 1:301 E WENDOVER AVE STE 200
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1232
Practice Address - Country:US
Practice Address - Phone:336-274-3241
Practice Address - Fax:336-272-7134
Is Sole Proprietor?:No
Enumeration Date:2019-02-07
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-08832207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine