Healthcare Provider Details

I. General information

NPI: 1336272822
Provider Name (Legal Business Name): DOLORES ANN MILLER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 03/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9600 ROOSEVELT BLVD SUITE 202
PHILADELPHIA PA
19115-3932
US

IV. Provider business mailing address

2647 BROWNSVILLE RD
LANGHORNE PA
19053-3203
US

V. Phone/Fax

Practice location:
  • Phone: 215-677-9870
  • Fax: 215-677-0977
Mailing address:
  • Phone: 267-568-2245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA050823
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberOA000814
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: