Healthcare Provider Details

I. General information

NPI: 1255385803
Provider Name (Legal Business Name): GERALD MILEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 02/10/2020
Certification Date: 02/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 PARKER HILL AVE
BOSTON MA
02120-2847
US

IV. Provider business mailing address

125 PARKER HILL AVE
BOSTON MA
02120-2847
US

V. Phone/Fax

Practice location:
  • Phone: 617-738-9600
  • Fax:
Mailing address:
  • Phone: 617-754-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number37761
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: