Healthcare Provider Details

I. General information

NPI: 1265572093
Provider Name (Legal Business Name): MARK ANDREW MILLER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 E MEDICAL LN STE 400
WEST COLUMBIA SC
29169-4848
US

IV. Provider business mailing address

2020 TECHNOLOGY PKWY STE 3100
MECHANICSBURG PA
17050-9426
US

V. Phone/Fax

Practice location:
  • Phone: 803-794-7511
  • Fax: 803-794-7751
Mailing address:
  • Phone: 717-221-5940
  • Fax: 717-233-1939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number95419
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0102201618
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberOS014115
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberOS014115
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: