Provider Demographics
NPI:1679592430
Name:MILLER, DAVID WELDON (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WELDON
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:125 QUEENS RD STE 640
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3580
Practice Address - Country:US
Practice Address - Phone:980-302-6761
Practice Address - Fax:980-302-6762
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600137207R00000X, 207RX0202X, 207RH0000X
NC55000207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN00137Medicaid
NC1679592430Medicaid
NC8959344Medicaid
NC2224411MMedicare PIN
NC830007794Medicare PIN
NCNC6356AMedicare UPIN
NCG28263Medicare UPIN
NC1679592430Medicaid
NC2224411JMedicare PIN
NC2224411BMedicare PIN