Basic Information
| Provider Information | |||||||||
| NPI: | 1841387255 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1063 | ||||||||
| Address2: | |||||||||
| City: | BURLINGTON | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054021063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028470000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 111 COLCHESTER AVE | ||||||||
| Address2: | |||||||||
| City: | BURLINGTON | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054011473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028470000 | ||||||||
| FaxNumber: | 8028470000 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2006 | ||||||||
| LastUpdateDate: | 06/29/2011 | ||||||||
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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 | 224571101 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 042-0010375 | VT | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000404191002 | 01 | NY | BS OF NENY | OTHER | 110242711 | 01 | NY | RAILROAD MEDICARE | OTHER | 114406 | 01 | NY | VALUE OPTIONS | OTHER | 141338471 | 01 | NY | FIDELIS | OTHER | 602938 | 01 | NY | MVP | OTHER | 02315295 | 05 | NY | MEDICAID | 141338471 | 01 | NY | GHI | OTHER | 7064698 | 01 | NM | AETNA | OTHER | P010224571 | 01 | NY | EXCELLUS UTICA WATERTOWN | OTHER | JM055S6810 | 01 | NY | EMPIRE BC/BS | OTHER |