Provider Demographics
NPI:1679815039
Name:MILLER, LAURA JANE (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:JANE
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 1:1439 CAMBRIDGE ST
Mailing Address - Street 2:ROOM 206 MACHT BUILDING
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-1106
Mailing Address - Country:US
Mailing Address - Phone:617-665-1187
Mailing Address - Fax:
Practice Address - Street 1:1439 CAMBRIDGE ST
Practice Address - Street 2:ROOM 206 MACHT BUILDING
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-1106
Practice Address - Country:US
Practice Address - Phone:617-665-1187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-25
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAIN PROCESS2084P0800X
GA770412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry