Provider Demographics
NPI:1972540912
Name:MILLER, TODD W (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:W
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 1:149 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4974
Mailing Address - Country:US
Mailing Address - Phone:207-872-1270
Mailing Address - Fax:207-872-1831
Practice Address - Street 1:149 NORTH ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4974
Practice Address - Country:US
Practice Address - Phone:207-872-1270
Practice Address - Fax:207-872-1831
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME015780208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
110231775OtherRAILROAD MEDICARE
2718870OtherAETNA HMO
7716319OtherAETNA NON HMO
MN5058OtherHARVARD PILGRIM
ME045003OtherANTHEM
ME331810099Medicaid
ME288620999Medicaid
MN5058OtherHARVARD PILGRIM
MM9188Medicare PIN