Healthcare Provider Details

I. General information

NPI: 1336299494
Provider Name (Legal Business Name): JENNIFER U MILES-THOMAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER ULANDA MILES

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 CLEARFIELD AVE
VA BEACH VA
23462-1815
US

IV. Provider business mailing address

225 CLEARFIELD AVE
VA BEACH VA
23462-1815
US

V. Phone/Fax

Practice location:
  • Phone: 757-457-5100
  • Fax: 757-818-7762
Mailing address:
  • Phone: 757-457-5100
  • Fax: 757-819-7762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number0101244441
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2088F0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Urology) Physician
License Number0101244441
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number036168591
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: