Provider Demographics
NPI:1578534640
Name:MILLER, JEFFREY S (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:S
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 1:19 GRANDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06759-4107
Mailing Address - Country:US
Mailing Address - Phone:860-567-8542
Mailing Address - Fax:860-496-0251
Practice Address - Street 1:538 LITCHFIELD ST
Practice Address - Street 2:SUITE 101
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-6669
Practice Address - Country:US
Practice Address - Phone:860-496-1790
Practice Address - Fax:860-496-0251
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT031168207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001311688Medicaid
CT001311688Medicaid
CT440000039Medicare ID - Type Unspecified