Provider Demographics
NPI:1932197795
Name:MILLER, DAVID C (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:C
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 1:5608 YORKE ST NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-5338
Mailing Address - Country:US
Mailing Address - Phone:704-795-4778
Mailing Address - Fax:
Practice Address - Street 1:4315 PHYSICIANS BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-7430
Practice Address - Country:US
Practice Address - Phone:704-996-3737
Practice Address - Fax:704-364-4422
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC96-00088207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891125UMedicaid
NC891125UMedicaid