Healthcare Provider Details

I. General information

NPI: 1093755829
Provider Name (Legal Business Name): JOEL P MILLER DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 09/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3998 RED LION RD SUITE 209
PHILADELPHIA PA
19114-1436
US

IV. Provider business mailing address

3998 RED LION RD SUITE 209
PHILADELPHIA PA
19114-1436
US

V. Phone/Fax

Practice location:
  • Phone: 215-824-2859
  • Fax: 215-824-3963
Mailing address:
  • Phone: 215-824-2859
  • Fax: 215-824-3963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberOS003385L
License Number StatePA

VIII. Authorized Official

Name: JODY L ORR
Title or Position: BUSINESS MANAGER
Credential:
Phone: 215-824-3913