Provider Demographics
NPI:1366479297
Name:MILLER, HILARY DAWN (DO)
Entity type:Individual
Prefix:
First Name:HILARY
Middle Name:DAWN
Last Name:MILLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GLENVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26351
Mailing Address - Country:US
Mailing Address - Phone:304-462-7460
Mailing Address - Fax:304-462-7461
Practice Address - Street 1:604 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GLENVILLE
Practice Address - State:WV
Practice Address - Zip Code:26351
Practice Address - Country:US
Practice Address - Phone:304-462-7460
Practice Address - Fax:304-462-7461
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1999207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810002135Medicaid
I19680Medicare UPIN
WVLI9353521Medicare ID - Type Unspecified