Healthcare Provider Details

I. General information

NPI: 1508993197
Provider Name (Legal Business Name): KOREN MILLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 08/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4735 OGLETOWN STANTON RD SUITE 2121, MAP 2
NEWARK DE
19713-2072
US

IV. Provider business mailing address

4745 OGLETOWN-STANTON ROAD STE 2A00
NEWARK DE
19718-0001
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-4503
  • Fax:
Mailing address:
  • Phone: 302-733-1042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberC7-0002201
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: