Provider Demographics
NPI:1891779658
Name:MILLER, GEOFFREY (MB CHB)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:MB CHB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 YORK ST
Mailing Address - Street 2:YNHH CHILDREN'S HOSPITAL - WP-2
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3220
Mailing Address - Country:US
Mailing Address - Phone:203-785-4081
Mailing Address - Fax:203-785-3833
Practice Address - Street 1:20 YORK ST
Practice Address - Street 2:YNHH CHILDREN'S HOSPITAL - WP-2
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:203-785-4081
Practice Address - Fax:203-785-3833
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0427932084N0402X, 2084P0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No2084P0005XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurodevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001427930Medicaid
CT370001563Medicare ID - Type Unspecified
F18963Medicare UPIN