Healthcare Provider Details

I. General information

NPI: 1710176466
Provider Name (Legal Business Name): DEBRA T MILLER MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2007
Last Update Date: 10/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 S RIVER ST
PLAINS PA
18705-1137
US

IV. Provider business mailing address

220 S RIVER ST
PLAINS PA
18705-1137
US

V. Phone/Fax

Practice location:
  • Phone: 570-824-8151
  • Fax:
Mailing address:
  • Phone: 570-824-8151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD034590E
License Number StatePA

VIII. Authorized Official

Name: DR. DEBRA T MILLER
Title or Position: OWNER
Credential: MD
Phone: 570-824-8151