Provider Demographics
NPI:1588684468
Name:MILLER, FRED H (MD)
Entity type:Individual
Prefix:
First Name:FRED
Middle Name:H
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:PO BOX 60099
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0099
Mailing Address - Country:US
Mailing Address - Phone:803-328-0181
Mailing Address - Fax:803-328-0553
Practice Address - Street 1:2450 INDIA HOOK ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3271
Practice Address - Country:US
Practice Address - Phone:803-328-0181
Practice Address - Fax:803-328-0553
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18157207R00000X
NC35990207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110136888OtherRR MEDICARE
NC58936OtherBCBS-NC
SC181574Medicaid
SC181574Medicaid
SCD061341909Medicare PIN
110136888OtherRR MEDICARE