Provider Demographics
NPI:1982648333
Name:MILLER, TIMOTHY CHARLES (MD)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:CHARLES
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:301 S PRICE ST
Mailing Address - Street 2:STE 1
Mailing Address - City:KINGWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26537
Mailing Address - Country:US
Mailing Address - Phone:304-329-3300
Mailing Address - Fax:304-329-3301
Practice Address - Street 1:301 S PRICE ST
Practice Address - Street 2:STE 1
Practice Address - City:KINGWOOD
Practice Address - State:WV
Practice Address - Zip Code:26537
Practice Address - Country:US
Practice Address - Phone:304-329-3300
Practice Address - Fax:304-329-3301
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12569208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
001720432OtherBCBS
241412OtherMAMSI
020003912OtherRR MEDICARE
1310927OtherUMWA
WV0545611Medicare PIN
241412OtherMAMSI