Healthcare Provider Details

I. General information

NPI: 1568013852
Provider Name (Legal Business Name): DEREK M MILLER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2019
Last Update Date: 09/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 CHAPLINE ST
WHEELING WV
26003-3875
US

IV. Provider business mailing address

2101 CHAPLINE ST
WHEELING WV
26003-3875
US

V. Phone/Fax

Practice location:
  • Phone: 304-232-7151
  • Fax:
Mailing address:
  • Phone: 304-232-7151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: