Provider Demographics
NPI:1578537452
Name:MILLER, ROBERTA N (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:N
Last Name:MILLER
Suffix:
Gender:F
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:PO BOX 3203
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12303-0203
Mailing Address - Country:US
Mailing Address - Phone:518-346-3100
Mailing Address - Fax:518-688-1342
Practice Address - Street 1:16 CRIMSON OAK CT
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12309-2234
Practice Address - Country:US
Practice Address - Phone:518-346-3100
Practice Address - Fax:518-688-1342
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1814681207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01597001Medicaid
NYIA0862Medicare PIN
NY01597001Medicaid