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General NPI Number Information
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NPI Number | 1033291059
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Entity Type | Individual
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Provider Name | DEREK MATTHEW MILETICH M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 09/10/2024
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Provider Practice Location Address
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Address Line | PSC 1005 BOX 11185
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City | FPO
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State | AA
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Zip | 34009-0112
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Country | US
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Telephone | 757-458-2650
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Fax |
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Provider Business Mailing Address
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Address Line | 111 HIGH ST SUITE 406
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City | PORTSMOUTH
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State | VA
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Zip | 23704-3845
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | C170957
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2084P2900X
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Taxonomy Name | Pain Medicine (Psychiatry & Neurology) Physician
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License Number | C170957
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License Number State | CA
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