Healthcare Provider Details

I. General information

NPI: 1992709968
Provider Name (Legal Business Name): GERARD A. MILLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 DARBY RD SUITE 203
HAVERTOWN PA
19083-4639
US

IV. Provider business mailing address

510 DARBY RD SUITE 203
HAVERTOWN PA
19083-4639
US

V. Phone/Fax

Practice location:
  • Phone: 610-789-7600
  • Fax: 610-449-1287
Mailing address:
  • Phone: 610-789-7600
  • Fax: 610-449-1287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberMD040653E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: