Provider Demographics
NPI:1881679439
Name:MILLER, BRIGITTE (MD)
Entity Type:Individual
Prefix:
First Name:BRIGITTE
Middle Name:
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:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1350 S KINGS DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-2134
Practice Address - Country:US
Practice Address - Phone:704-446-1255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200001208207VX0201X, 207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4252679OtherBCBS
NC1881679439Medicaid
SCQ08000Medicaid
NC891263RMedicaid
NC232009OtherMEDICARE PTAN, CMC-NORTHEAST GROUP
VA6202837Medicaid
4252679OtherAETNA
99201OtherMEDCOST
NC2280821DOtherMEDICARE INDIVIDUAL PIN, LINKED TO CMCNE
WV3000257000Medicaid
NC36489OtherPARTNERS
NC4252679OtherBCBS
NC2280821CMedicare PIN
99201OtherMEDCOST
4252679OtherAETNA
NC36489OtherPARTNERS
NC2280821DOtherMEDICARE INDIVIDUAL PIN, LINKED TO CMCNE
E64863Medicare UPIN
SCQ08000Medicaid