Healthcare Provider Details

I. General information

NPI: 1194785436
Provider Name (Legal Business Name): MYRON D MILLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S. TAN ST., SUITE1 FREDERICKSBURG COMMUNITY HEALTH CENTER, P.C.
FREDERICKSBURG PA
17026-0009
US

IV. Provider business mailing address

120 S TAN ALY STE 1
FREDERICKSBURG PA
17026-9349
US

V. Phone/Fax

Practice location:
  • Phone: 717-865-6644
  • Fax: 717-865-7321
Mailing address:
  • Phone: 717-865-6644
  • Fax: 717-865-5666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD039873E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: