Provider Demographics
NPI:1487608774
Name:MILLER, LAURA MARTIN (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MARTIN
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 1:3260 SACRAMENTO ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94702-2739
Mailing Address - Country:US
Mailing Address - Phone:510-601-6060
Mailing Address - Fax:
Practice Address - Street 1:10700 MACARTHUR BLVD
Practice Address - Street 2:SUITE 14B
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-5298
Practice Address - Country:US
Practice Address - Phone:510-563-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80037207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ89670ZOtherPTAN
CAZZZ89670ZOtherPTAN