Provider Demographics
NPI:1992884282
Name:MILLER, ROBERT JAMES (MD)
Entity type:Individual
Prefix:MR
First Name:ROBERT
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 1:10 GROVE STREET
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE FALLS
Mailing Address - State:MA
Mailing Address - Zip Code:01370
Mailing Address - Country:US
Mailing Address - Phone:413-625-6021
Mailing Address - Fax:413-625-6073
Practice Address - Street 1:10 GROVE STREET
Practice Address - Street 2:
Practice Address - City:SHELBURNE FALLS
Practice Address - State:MA
Practice Address - Zip Code:01370
Practice Address - Country:US
Practice Address - Phone:413-625-6021
Practice Address - Fax:413-625-6073
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA51476207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6172709Medicaid
B96401Medicare UPIN
J02434Medicare PIN