Basic Information
| Provider Information | |||||||||
| NPI: | 1750376331 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | PHILIP | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3100 BLUE RIDGE RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276128036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197817500 | ||||||||
| FaxNumber: | 9196453440 | ||||||||
| Practice Location | |||||||||
| Address1: | 3100 BLUE RIDGE RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276128036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197817500 | ||||||||
| FaxNumber: | 9196453440 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2005 | ||||||||
| LastUpdateDate: | 05/26/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 15535 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8959160 | 05 | NC | MEDICAID |