Provider Demographics
NPI:1144206236
Name:MILLER, CAROLYN ILENE (MD)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:ILENE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2061 EVELYN BYRD AVE STE C
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-3442
Mailing Address - Country:US
Mailing Address - Phone:540-442-8056
Mailing Address - Fax:540-442-8022
Practice Address - Street 1:2061 EVELYN BYRD AVE STE C
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-3442
Practice Address - Country:US
Practice Address - Phone:540-442-8056
Practice Address - Fax:540-442-8022
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057474207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G70692Medicare UPIN
VA00W404R01Medicare ID - Type UnspecifiedPROVIDER NUMBER