Healthcare Provider Details

I. General information

NPI: 1801880067
Provider Name (Legal Business Name): MATTHEW JAMES MILES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 NEW SCOTLAND AVE
ALBANY NY
12208-3412
US

IV. Provider business mailing address

47 NEW SCOTLAND AVE
ALBANY NY
12208-3412
US

V. Phone/Fax

Practice location:
  • Phone: 518-262-3773
  • Fax: 518-262-3236
Mailing address:
  • Phone: 518-262-3773
  • Fax: 518-262-3236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number229291
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: