| Gary Miller Md Llc | |
|
61 Bradley St Bristol CT 06010 | |
| (860) 314-6898 | |
| (860) 314-6896 |
| Full Name | Gary Miller Md Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 61 Bradley St, Bristol, Connecticut |
| Authorized Official Name and Position | Gary Miller (OWNER) |
| Authorized Official Contact | 8603146898 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gary Miller Md Llc 61 Bradley St Bristol CT 06010 Ph: (860) 314-6898 | Gary Miller Md Llc 61 Bradley St Bristol CT 06010 Ph: (860) 314-6898 |
| NPI Number | 1396713061 |
|---|---|
| Provider Enumeration Date | 03/09/2006 |
| Last Update Date | 11/24/2009 |
| Medicare PECOS PAC ID | 8022062223 |
|---|---|
| Medicare Enrollment ID | O20050310000469 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396713061 | NPI | - | NPPES |
| 07D0092369 | Other | CLIA | |
| 004220985 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Gary Miller |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1528027430 PECOS PAC ID: 7911951116 Enrollment ID: I20091118000604 |
| Provider Name | Danielle M Grillo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013391101 PECOS PAC ID: 3779893581 Enrollment ID: I20151106001538 |
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