Provider Demographics
NPI:1730159872
Name:GARTH A MILLER MD PA
Entity type:Organization
Organization Name:GARTH A MILLER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARTH
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-633-3320
Mailing Address - Street 1:PO BOX 145
Mailing Address - Street 2:14 ST ANDREWS LANE
Mailing Address - City:BOOTHBAY HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04538
Mailing Address - Country:US
Mailing Address - Phone:207-633-3320
Mailing Address - Fax:207-633-7030
Practice Address - Street 1:14 ST ANDREWS LN
Practice Address - Street 2:
Practice Address - City:BOOTHBAY HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04538
Practice Address - Country:US
Practice Address - Phone:207-633-3320
Practice Address - Fax:207-633-7030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME013198207RG0100X, 208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Not Answered208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C91362Medicare UPIN
MEMM3924Medicare ID - Type Unspecified