Provider Demographics
NPI:1700854361
Name:MILLER, ROY S (MD)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:S
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 207
Mailing Address - Street 2:
Mailing Address - City:COOPERS MILLS
Mailing Address - State:ME
Mailing Address - Zip Code:04341-0207
Mailing Address - Country:US
Mailing Address - Phone:207-549-7420
Mailing Address - Fax:
Practice Address - Street 1:47 MAIN ST
Practice Address - Street 2:SHEEPSCOT VALLEY HEALTH CTR
Practice Address - City:COOPERS MILLS
Practice Address - State:ME
Practice Address - Zip Code:04341
Practice Address - Country:US
Practice Address - Phone:207-549-7581
Practice Address - Fax:207-549-3439
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME009804207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME323640099Medicaid
MI055270Medicare ID - Type Unspecified
C66565Medicare UPIN