Healthcare Provider Details

I. General information

NPI: 1437137908
Provider Name (Legal Business Name): DR. GERALD MILEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 PARKER HILL AVE FOGG BLDG SUITE 308
ROXBURY CROSSING MA
02120-2847
US

IV. Provider business mailing address

125 PARKER HILL AVE FOGG BLDG SUITE 308
ROXBURY CROSSING MA
02120-2847
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number37761
License Number StateMA

VIII. Authorized Official

Name: GERLAD MILEY
Title or Position: DOCTOR
Credential: M.D.
Phone: 617-738-9600