Basic Information
| Provider Information | |||||||||
| NPI: | 1093753345 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | WAYNE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | SR. | ||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 1115 BOULDERS PKWY | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | NORTH CHESTERFIELD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232254067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8045605595 | ||||||||
| FaxNumber: | 8045609029 | ||||||||
| Practice Location | |||||||||
| Address1: | 1115 BOULDERS PKWY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | NORTH CHESTERFIELD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232254067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8043201339 | ||||||||
| FaxNumber: | 8043305829 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2006 | ||||||||
| LastUpdateDate: | 09/12/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 09/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0114X | 0101045888 | VA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery | 207X00000X | 0101045888 | VA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1093753345 | 05 | VA | MEDICAID | 200035192 | 01 | VA | RAILROAD MEDICARE | OTHER | 0900834 | 01 | VA | UNITED HEALTHCARE | OTHER | 2214891 | 01 | VA | AETNA HMO | OTHER | 288507 | 01 | VA | SOUTHERN HEALTH | OTHER | 540885859 | 01 | VA | CIGNA | OTHER | 540885859 | 01 | VA | PRIVATE HEALTHCARE SYSTEM | OTHER | 17552 | 01 | VA | SH CARENET | OTHER | 2138283 | 01 | VA | UNITED HEALTHCARE MAMSI | OTHER | 23501 | 01 | VA | OPTIMA HEALTH | OTHER | 386536 | 01 | VA | ANTHEM WEST END OPERATORY | OTHER | 540885859 | 01 | VA | CORVEL | OTHER | 226981 | 01 | VA | ANTHEM HEALTHKEEPERS | OTHER | 540885859 | 01 | VA | FIRST HEALTH/CCN | OTHER | 540885859 | 01 | VA | C&O EMPLOYEES HEALTHCARE | OTHER | 540885859 | 01 | VA | COMPMANAGEMENT | OTHER | 006407587 | 05 | VA | MEDICAID | 540885859 | 01 | VA | FOCUS | OTHER |