Provider Demographics
NPI:1053351064
Name:MILLER, DENA (MD)
Entity type:Individual
Prefix:
First Name:DENA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 CRESCENT ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3654
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:28 CRESCENT ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3654
Practice Address - Country:US
Practice Address - Phone:860-358-6000
Practice Address - Fax:860-358-6071
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2322102085R0202X
CT381332085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001381334Medicaid
NY02883136Medicaid
NYA400154401OtherMEDICARE PTAN
CT001381334Medicaid
NY02883136Medicaid
CT300004112Medicare PIN
CT010038133CT09OtherANTHEM BC/BS
CT010038133CT14OtherANTHEM BC/BS
NYH18525Medicare UPIN
CT300004091Medicare PIN
CT300004090Medicare PIN
CT010038133CT17OtherANTHEM BC/BS
CT001381334Medicaid
CT300004093Medicare PIN
CT300004087Medicare PIN
CT300004089Medicare PIN