Individual
MISS MARY IRENE MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
ONE POMPERAUG OFFICE PARK, SUITE 104, SOUTHBURY, CT 06488
(203) 262-6900
(203) 262-6045
Mailing address
ONE POMPERAUG OFFICE PARK, SUITE 104, SOUTHBURY, CT 06488
(203) 262-6900
(203) 262-6045
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
034922
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00134922501
FAMILY PLAN
—
01
—
00134922CT07
BLUE CROSS
—
01
—
03492Z
CONCTCARE
—
01
—
LIP063
OXFORD
—
01
—
OR4281
HEALTH NET
—
Enumeration date
07/13/2006
Last updated
07/08/2007
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