Provider Demographics
NPI:1710036272
Name:MILLER, STEWART L (PA-C)
Entity Type:Individual
Prefix:MR
First Name:STEWART
Middle Name:L
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 1:5446 MIDSHIP CT
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-1911
Mailing Address - Country:US
Mailing Address - Phone:254-462-2955
Mailing Address - Fax:
Practice Address - Street 1:WHITE HOUSE MEDICAL UNIT
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20502-0001
Practice Address - Country:US
Practice Address - Phone:202-757-2499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03523363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant