Provider Demographics
NPI:1972740124
Name:MILLER, RONALD L (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:L
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 1:874 HOWARD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1106
Mailing Address - Country:US
Mailing Address - Phone:203-688-8200
Mailing Address - Fax:203-688-8204
Practice Address - Street 1:874 HOWARD AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1106
Practice Address - Country:US
Practice Address - Phone:203-688-8200
Practice Address - Fax:203-688-8204
Is Sole Proprietor?:No
Enumeration Date:2009-01-09
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT022944207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1972740124OtherTRICARE
CT2237728OtherCOVENTRY
CT4125132OtherAETNA
CTP00849949OtherRR MEDICARE
CT1972740124OtherUNITED HEALTHCARE
CT1972740124OtherHARVARD PILGRIM
CT1972740124OtherMULTIPLAN
CT022944OtherCIGNA
CT1972740124OtherCONNECTICARE
CT1972740124OtherHEALTHY CT
CTP4193701OtherOXFORD
CT1972740124Medicaid
CT1972740124OtherANTHEM
CT905555OtherWELLCARE
CT1972740124OtherTRICARE