Provider Demographics
NPI:1679647432
Name:MILLER, MARSHA MAXINE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARSHA
Middle Name:MAXINE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17 EDGEHILL RD
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-2712
Mailing Address - Country:US
Mailing Address - Phone:401-863-9535
Mailing Address - Fax:401-863-7953
Practice Address - Street 1:BROWN UNIVERSITY HEALTH SERVICES
Practice Address - Street 2:BROWN UNIVERSITY, 13 BROWN STREET
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02912-0001
Practice Address - Country:US
Practice Address - Phone:401-863-9535
Practice Address - Fax:401-863-7953
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI7396207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI15939Medicare UPIN