Healthcare Provider Details

I. General information

NPI: 1265416846
Provider Name (Legal Business Name): PAUL M MILLER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 09/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 CENTRAL AVE
PHILADELPHIA PA
19111-2442
US

IV. Provider business mailing address

PO BOX 820933
PHILADELPHIA PA
19182-0933
US

V. Phone/Fax

Practice location:
  • Phone: 215-728-2000
  • Fax: 215-214-4119
Mailing address:
  • Phone: 215-728-2000
  • Fax: 215-214-4119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberOS004829L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: