Provider Demographics
NPI:1275506446
Name:MILLER, THERESA L (MD)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:L
Last Name:MILLER
Suffix:
Gender:F
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:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-0388
Mailing Address - Country:US
Mailing Address - Phone:540-932-4629
Mailing Address - Fax:540-932-5875
Practice Address - Street 1:22 N MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2344
Practice Address - Country:US
Practice Address - Phone:540-213-2630
Practice Address - Fax:540-213-2631
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101051765207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA700011406OtherCIGNA
VA285567OtherANTHEM
VA142720OtherSOUTHERN HEALTH
VA005853575Medicaid
VA2182360OtherFIRST HEALTH
VA41819OtherOPTIMA
VA5853575OtherVA PREMIER
VA2182360OtherFIRST HEALTH
VA110007960Medicare ID - Type Unspecified
VAC00264Medicare PIN
VA110121294Medicare PIN
VA41819OtherOPTIMA
VA142720OtherSOUTHERN HEALTH