Provider Demographics
NPI:1871517946
Name:MILLER, SUSAN (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:110 HO PLAZA
Mailing Address - Street 2:GANNETT HEALTH SERVICES CORNELL UNIVERSITY
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14853-3101
Mailing Address - Country:US
Mailing Address - Phone:607-255-6946
Mailing Address - Fax:607-254-3503
Practice Address - Street 1:110 HO PLAZA
Practice Address - Street 2:GANNETT HEALTH SERVICES CORNELL UNIVERSITY
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14853-3101
Practice Address - Country:US
Practice Address - Phone:607-255-6946
Practice Address - Fax:607-254-3503
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY201726-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB-76707Medicare UPIN