Provider Demographics
NPI:1336194935
Name:MILLER, STEPHEN BLAINE (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:BLAINE
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 1:5187 US ROUTE 60 E
Mailing Address - Street 2:SUITE # 9
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705-2076
Mailing Address - Country:US
Mailing Address - Phone:304-399-2222
Mailing Address - Fax:304-399-2223
Practice Address - Street 1:5187 US ROUTE 60 E
Practice Address - Street 2:SUITE # 9
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-2076
Practice Address - Country:US
Practice Address - Phone:304-399-2222
Practice Address - Fax:304-399-2223
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV18744208200000X
OH81842208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1000263000Medicaid
WV001722820OtherBLUE CROSS
066033492OtherAETNA
WV240007609OtherRAILROAD MEDICARE
WV1057260OtherWV WORKER'S COMP
WV1000263000Medicaid
066033492OtherAETNA