Provider Demographics
NPI:1588866818
Name:MILLER, GARY JAMES (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:JAMES
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 897
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26507-0897
Mailing Address - Country:US
Mailing Address - Phone:304-293-7401
Mailing Address - Fax:304-293-6963
Practice Address - Street 1:1255 PINEVIEW DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2738
Practice Address - Country:US
Practice Address - Phone:304-598-3301
Practice Address - Fax:304-599-7346
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22318208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVCA7030OtherRAILROAD MEDICAR GROUP
WV3810012202Medicaid
WVP00623109OtherRAILROAD MEDICARE
WVMI6037071Medicare PIN