Healthcare Provider Details

I. General information

NPI: 1285632646
Provider Name (Legal Business Name): FRANKFORD AVENUE FAMILY PRACTICE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 11/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8846 FRANKFORD AVE
PHILADELPHIA PA
19136-1313
US

IV. Provider business mailing address

8846 FRANKFORD AVE
PHILADELPHIA PA
19136-1313
US

V. Phone/Fax

Practice location:
  • Phone: 215-332-8221
  • Fax: 215-332-2979
Mailing address:
  • Phone: 215-332-8221
  • Fax: 215-332-2979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StatePA

VIII. Authorized Official

Name: DR. PAUL H MILLER
Title or Position: DO
Credential:
Phone: 215-332-8221