MEDICARE: DR. GLENN MILLER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician	MD033553E	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	050088759	OTHER	PA	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20033920	OTHER	NJ	AMERIHEALTH MERCY
3	30003770	OTHER	NJ	HORIZON NJ HEALTH
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	517607	OTHER	NJ	AMERIHEALTH ADMINISTRATOR
6	0112230205	OTHER	PA	ALL IBC PRODUCTS
7	3039	OTHER	PA	BRAVO BY ELDER HEALTH
8	517607	OTHER	PA	ALL BLUE SHIELD
9	0111120000	OTHER	NJ	AMERIHEALTH PC & HMO
10	2992866	OTHER	PA	AETNA
11	30003770	OTHER	PA	KEYSTONE MERCY

General Provider Information

NPI Number	:	1174697346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLENN MILLER M.D.

Provider Business Mailing Address
First Line	:	3831 RAMAGE RUN
Second Line	:
City	:	HUNTINGDON VALLEY
State	:	PA
Zip	:	19006-2453
Country	:	US
Telephone Number	:	215-938-0254
Fax Number	:

Provider Business Practice Location Address
First Line	:	2410 S BROAD ST
Second Line	:	3RD FLR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-4418
Country	:	US
Telephone Number	:	215-462-6600
Fax Number	:	215-462-2650

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	07/08/2007

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