Provider Demographics
NPI:1639111891
Name:MILLER, BETHANY LUCIANI (PA-C)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:LUCIANI
Last Name:MILLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 NORWICH NEW LONDON TPKE
Mailing Address - Street 2:
Mailing Address - City:UNCASVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06382-2527
Mailing Address - Country:US
Mailing Address - Phone:860-848-1297
Mailing Address - Fax:860-848-9875
Practice Address - Street 1:80 NORWICH NEW LONDON TPKE
Practice Address - Street 2:
Practice Address - City:UNCASVILLE
Practice Address - State:CT
Practice Address - Zip Code:06382-2527
Practice Address - Country:US
Practice Address - Phone:860-848-1297
Practice Address - Fax:860-848-9875
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1434207RC0000X
CT001434363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
290001434CT01OtherANTHEM/ECCG:06-1049086
625224OtherCONNECTICARE
P3617313OtherOXFORD/ECCD: 06-1616101
P3495612OtherOXFORD/ECCG: 06-1049086
2V5291OtherHEALTHNET/ECCD:06-1616101
2V5290OtherHEALTHNET/ECCG:06-1049086
2V5290OtherHEALTHNET/ECCG:06-1049086
290001434CT01OtherANTHEM/ECCG:06-1049086
P3495612OtherOXFORD/ECCG: 06-1049086