Provider Demographics
NPI:1184692162
Name:MILLER, JEFFREY ADAM (DO)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ADAM
Last Name:MILLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6 SHAWS CV
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-4969
Mailing Address - Country:US
Mailing Address - Phone:860-444-9022
Mailing Address - Fax:860-444-7768
Practice Address - Street 1:6 SHAWS CV
Practice Address - Street 2:SUITE 101
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-4969
Practice Address - Country:US
Practice Address - Phone:860-444-9022
Practice Address - Fax:860-444-7768
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT000371207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT6213590002Medicare NSC
CT1184692162Medicare NSC
CTE64217Medicare PIN
CT1275554222Medicare NSC
P00094449Medicare PIN