Basic Information
Provider Information
NPI: 1295702116
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MILLER
FirstName: AMY
MiddleName: LEIGH
NamePrefix: DR.
NameSuffix:  
Credential: MD, PHD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 111 CYPRESS ST
Address2:  
City: BROOKLINE
State: MA
PostalCode: 024456002
CountryCode: US
TelephoneNumber: 8573070896
FaxNumber:  
Practice Location
Address1: 70 FRANCIS ST
Address2: SHAPIRO CARDIOVASCULAR CENTER, BRIGHAM AND WOMEN'S
City: BOSTON
State: MA
PostalCode: 021156134
CountryCode: US
TelephoneNumber: 8573074000
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/01/2006
LastUpdateDate: 04/30/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0000X220828MAY Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease

No ID Information.


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