Provider Demographics
NPI:1447340112
Name:MILLER, GARY PRICE (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:PRICE
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 1:158 EXECUTIVE DRIVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-4100
Mailing Address - Country:US
Mailing Address - Phone:434-791-1088
Mailing Address - Fax:434-799-8525
Practice Address - Street 1:158 EXECUTIVE DRIVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-4100
Practice Address - Country:US
Practice Address - Phone:434-791-1088
Practice Address - Fax:434-799-8525
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13684207RC0000X
NC38394207RC0000X
VA01010289752086S0129X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890541JOtherNC MEDICAID
VA099349OtherANTHEM
VA6055516Medicaid
NC890541JOtherNC MEDICAID
E19466Medicare UPIN