Provider Demographics
NPI:1174577464
Name:MILLER, LUCINDA (MD)
Entity type:Individual
Prefix:
First Name:LUCINDA
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 1:111 W STONE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-6027
Mailing Address - Country:US
Mailing Address - Phone:423-247-5197
Mailing Address - Fax:423-247-5254
Practice Address - Street 1:111 W STONE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-6027
Practice Address - Country:US
Practice Address - Phone:423-247-5197
Practice Address - Fax:423-247-5254
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN40488207RP1001X
VA0101246370207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3336180Medicaid
TN2245527OtherUNITED HEALTHCARE
TN4115762OtherBLUE CROSS BLUE SHIELD
TN100050449OtherPHP TENN CARE
GAP00316446Medicare PIN
VAV V3879AMedicare PIN
H31612Medicare UPIN
TN3336180Medicare PIN
TN4115762OtherBLUE CROSS BLUE SHIELD
TN103I812846Medicare PIN
TN103I294701Medicare PIN
TN3287305Medicare PIN
VAV V3879BMedicare PIN
TN3336181Medicare PIN
TN3700107Medicare PIN