Provider Demographics
NPI:1609933399
Name:MILLER, WAYNE ALEXANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:ALEXANDER
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:PO BOX 711
Mailing Address - Street 2:2231 MEETINGHOUSE WAY
Mailing Address - City:WEST BARNSTABLE
Mailing Address - State:MA
Mailing Address - Zip Code:02668-0711
Mailing Address - Country:US
Mailing Address - Phone:508-362-3678
Mailing Address - Fax:
Practice Address - Street 1:2231 MEETINGHOUSE WAY
Practice Address - Street 2:
Practice Address - City:WEST BARNSTABLE
Practice Address - State:MA
Practice Address - Zip Code:02668-1404
Practice Address - Country:US
Practice Address - Phone:508-362-3678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA41376207SC0300X, 207SG0201X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207SC0300XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Cytogenetics
Not Answered207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Not Answered207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAB98708Medicare UPIN
MAM09635Medicare ID - Type UnspecifiedMEDICARE