Provider Demographics
NPI:1720062938
Name:MILLER, RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
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 1:1922 THOMSON DR STE B
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-1020
Mailing Address - Country:US
Mailing Address - Phone:434-846-4444
Mailing Address - Fax:434-846-4445
Practice Address - Street 1:1922 THOMSON DR STE B
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1020
Practice Address - Country:US
Practice Address - Phone:434-846-4444
Practice Address - Fax:434-846-4445
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101059327207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5827221Medicaid
VA110189355OtherMEDICARE RAILROAD CARRIER
VA110189355OtherMEDICARE RAILROAD CARRIER
VA110007400Medicare ID - Type Unspecified