Provider Demographics
NPI:1730893900
Name:MILLER, MATTHEW S (PRSS)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:S
Last Name:MILLER
Suffix:
Gender:M
Credentials:PRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6607 PRICE BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25053-7952
Mailing Address - Country:US
Mailing Address - Phone:304-369-4500
Mailing Address - Fax:
Practice Address - Street 1:6607 PRICE BRANCH RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:WV
Practice Address - Zip Code:25053-7952
Practice Address - Country:US
Practice Address - Phone:304-369-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-11
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV23-908175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist