Provider Demographics
NPI:1578589339
Name:MILLER MURRAY, CECILE MAUGE (MD)
Entity Type:Individual
Prefix:DR
First Name:CECILE
Middle Name:MAUGE
Last Name:MILLER MURRAY
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 1:1624 MAIN STREET
Mailing Address - Street 2:AGAPE SENIOR PRIMARY CARE, INC
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2818
Mailing Address - Country:US
Mailing Address - Phone:803-726-2350
Mailing Address - Fax:803-753-9102
Practice Address - Street 1:1317 EBENEZER ROAD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732
Practice Address - Country:US
Practice Address - Phone:803-522-9175
Practice Address - Fax:803-207-8207
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36251207R00000X
NY231489207R00000X
NC2008-00915207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02700470Medicaid
NC5910965Medicaid
NCP00717905OtherRAILROAD MEDICARE
NC2022958Medicare PIN
NYI43842Medicare UPIN
NCP00717905OtherRAILROAD MEDICARE
NY157SL1Medicare PIN