Healthcare Provider Details

I. General information

NPI: 1902932189
Provider Name (Legal Business Name): EMILY STANWOOD MILLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2007
Last Update Date: 12/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 WHITE HORSE PIKE RT. 30
HADDON HEIGHTS NJ
08035-1908
US

IV. Provider business mailing address

112 WHITE HORSE PIKE RT. 30
HADDON HEIGHTS NJ
08035-1908
US

V. Phone/Fax

Practice location:
  • Phone: 856-546-8672
  • Fax: 856-546-5315
Mailing address:
  • Phone: 856-546-8672
  • Fax: 856-546-5315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number25MA04164600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: