Provider Demographics
NPI:1780883405
Name:MILLER, THOMAS A (DO)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:MILLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 US ROUTE 1 STE C
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-7174
Mailing Address - Country:US
Mailing Address - Phone:207-883-5532
Mailing Address - Fax:
Practice Address - Street 1:71 US ROUTE 1 STE C
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-7174
Practice Address - Country:US
Practice Address - Phone:207-883-5532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MET0712208000000X
UT7676017-12042080P0202X
MEDO29532080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1780883405Medicaid