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General NPI Number Information
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NPI Number | 1851304919
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Entity Type | Individual
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Provider Name | THERESA MILLER PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/13/2006
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Last Update Date | 02/13/2019
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Provider Practice Location Address
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Address Line | 2400 MARYLAND RD SUITE 20
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City | WILLOW GROVE
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State | PA
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Zip | 19090-1700
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Country | US
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Telephone | 215-830-8700
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Fax | 215-830-8715
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Provider Business Mailing Address
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Address Line | 833 CHESTNUT ST 1402
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City | PHILADELPHIA
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State | PA
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Zip | 19107-4404
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Country | US
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Telephone | 215-830-8700
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Fax | 267-339-3761
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA052222
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License Number State | PA
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