Provider Demographics
NPI:1124094883
Name:MILLER, EDWARD C (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:C
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MEDICAL PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4985
Mailing Address - Country:US
Mailing Address - Phone:757-252-5660
Mailing Address - Fax:757-548-9443
Practice Address - Street 1:300 MEDICAL PKWY STE 120
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4985
Practice Address - Country:US
Practice Address - Phone:757-252-5660
Practice Address - Fax:757-548-9443
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101032556207R00000X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA-001OtherCHAMPUS/TRICARE
VA250365OtherATHEM BC/BS VA/HK
VA263654OtherUHC/MAMSI/MDIPA
NC890582MMedicaid
PAROtherAETNA
PAROtherFIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY
VA006013236Medicaid
VA006053335Medicaid
VA110130157OtherRAILROAD MEDICARE
VA15070OtherOPTIMA/SENTARA
PAROtherVIRGINIA PREMIER HEALTH
PAROtherMULTIPLAN
NC0582MOtherBC/BS NC
PAROtherCIGNA
PAROtherCORVEL/CORCARE
PAROtherVIRGINIA HEALTH NETWORK
VA15792OtherSENTARA OHP/SHP
VA259542OtherANTHEM BCBS
PAROtherUSA MANAGED CARE
VA012450C92Medicare PIN
NC0582MOtherBC/BS NC
VA250365OtherATHEM BC/BS VA/HK
VA259542OtherANTHEM BCBS
PAROtherFIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY