Provider Demographics
NPI:1699824078
Name:MILLER, GARY ARTHUR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:ARTHUR
Last Name:MILLER
Suffix:
Gender:M
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 1:450 COLUMBUS BLVD
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06103-1801
Mailing Address - Country:US
Mailing Address - Phone:800-960-9780
Mailing Address - Fax:860-702-9446
Practice Address - Street 1:450 COLUMBUS BLVD
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06103-1801
Practice Address - Country:US
Practice Address - Phone:800-960-9780
Practice Address - Fax:860-702-9446
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001145363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical