=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437137908
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. GERALD MILEY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 125 PARKER HILL AVE FOGG BLDG SUITE 308
-----------------------------------------------------
City | ROXBURY CROSSING
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02120-2847
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-738-9600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 125 PARKER HILL AVE FOGG BLDG SUITE 308
-----------------------------------------------------
City | ROXBURY CROSSING
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02120-2847
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-738-9600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | GERLAD MILEY
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 617-738-9600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 37761
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------