Individual
A LARRY MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
311 MAPLE AVE W, STE H, VIENNA, VA 22180-4309
(703) 938-5660
(703) 242-8712
Mailing address
311 MAPLE AVE W, STE H, VIENNA, VA 22180-4309
(703) 938-5660
(703) 242-8712
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0101026494
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0101026494
MEDICAL LICENCE
VA
01
—
207KA0200X
TAXONOMY
—
Enumeration date
06/27/2005
Last updated
07/09/2007
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