Provider Demographics
NPI:1740273622
Name:MILLER, DAVID BROOKE (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:BROOKE
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 1:250 MEMORIAL DRIVE SUITE D
Mailing Address - Street 2:
Mailing Address - City:LURAY
Mailing Address - State:VA
Mailing Address - Zip Code:22835-1000
Mailing Address - Country:US
Mailing Address - Phone:540-743-6558
Mailing Address - Fax:540-743-3601
Practice Address - Street 1:250 MEMORIAL DRIVE SUITE D
Practice Address - Street 2:
Practice Address - City:LURAY
Practice Address - State:VA
Practice Address - Zip Code:22835-1000
Practice Address - Country:US
Practice Address - Phone:540-743-6558
Practice Address - Fax:540-743-3601
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101041320207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005609101Medicaid
VAE28888Medicare UPIN
VA005609101Medicaid