Healthcare Provider Details

I. General information

NPI: 1033119870
Provider Name (Legal Business Name): WAYNE MILLER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 10/23/2022
Certification Date: 10/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 HOLME AVE FL 3
PHILADELPHIA PA
19152-2096
US

IV. Provider business mailing address

1033 W GERMANTOWN PIKE
NORRISTOWN PA
19403-3905
US

V. Phone/Fax

Practice location:
  • Phone: 215-335-6028
  • Fax: 267-350-7441
Mailing address:
  • Phone: 610-539-8500
  • Fax: 610-539-0910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS005935L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: