Provider Demographics
NPI:1770565251
Name:MILLER, CHARLES LUTHER (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:LUTHER
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:PO BOX 8519
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-8519
Mailing Address - Country:US
Mailing Address - Phone:732-460-9840
Mailing Address - Fax:732-460-9848
Practice Address - Street 1:30 SHREWSBURY PLAZA
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4332
Practice Address - Country:US
Practice Address - Phone:732-542-2124
Practice Address - Fax:732-460-0496
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA2361500207RC0000X, 207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK4747OtherHEALTH NET OF NEW JERSEY
NJ273678OtherUNITED HEALTHCARE
549791OtherAETNA
110089519OtherMEDICARE RAILROAD
539442OtherEMPIRE BCBS OF NY
NJMP178OtherOXFORD HEALTH PLANS
NJ2423405Medicaid
539441OtherEMPIRE BCBS OF NY
OK4747OtherHEALTH NET OF NEW JERSEY
NJMP178OtherOXFORD HEALTH PLANS