Provider Demographics
NPI:1396915138
Name:A. LARRY MILLER, MD LTD
Entity type:Organization
Organization Name:A. LARRY MILLER, MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:A
Authorized Official - Middle Name:LARRY
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-938-5660
Mailing Address - Street 1:311 MAPLE AVE W
Mailing Address - Street 2:SUITE H
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4309
Mailing Address - Country:US
Mailing Address - Phone:703-938-5660
Mailing Address - Fax:
Practice Address - Street 1:311 MAPLE AVE W
Practice Address - Street 2:SUITE H
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4309
Practice Address - Country:US
Practice Address - Phone:703-938-5660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101026494261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty