Provider Demographics
NPI:1063445989
Name:MILLER, GREGORY H (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:H
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16000 JOHNSTON MEMORIAL DR
Mailing Address - Street 2:SUITE 212A
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24211-7664
Mailing Address - Country:US
Mailing Address - Phone:276-258-3740
Mailing Address - Fax:276-258-3745
Practice Address - Street 1:16000 JOHNSTON MEMORIAL DR
Practice Address - Street 2:SUITE 212A
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24211-7664
Practice Address - Country:US
Practice Address - Phone:276-258-3740
Practice Address - Fax:276-258-3745
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29164207RC0000X
VA0101048853207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1511019Medicaid
VAP00917549OtherRAILROAD MEDICARE
VA1063445989Medicaid
TN1511018Medicaid
KY64926512Medicaid
TNP00669341OtherRAILROAD MEDICARE
TN1511018Medicaid
VA015614B12Medicare PIN