Provider Demographics
NPI:1922665439
Name:MILLER, COREY SHAPHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:SHAPHARD
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 1:300 BROOKLINE AVENUE, BIDMC
Mailing Address - Street 2:DANA 501
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215
Mailing Address - Country:US
Mailing Address - Phone:514-589-7421
Mailing Address - Fax:617-667-8424
Practice Address - Street 1:300 BROOKLINE AVENUE, BIDMC
Practice Address - Street 2:DANA 501
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215
Practice Address - Country:US
Practice Address - Phone:514-589-7421
Practice Address - Fax:617-667-8424
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program