Provider Demographics
NPI:1881823821
Name:MILLER, PETER E (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:E
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 1:7605 FOREST AVE STE 308
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-4939
Mailing Address - Country:US
Mailing Address - Phone:804-288-7077
Mailing Address - Fax:
Practice Address - Street 1:7605 FOREST AVE STE 308
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4939
Practice Address - Country:US
Practice Address - Phone:804-288-7077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-13
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA240934208600000X
VA0101260090208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101260090OtherMEDICAL LICENSE
RILP03381OtherLIMITED LICENSE NUMBER
C04411OtherMEDICARE PTAN