Provider Demographics
NPI:1093755829
Name:JOEL P MILLER DO PC
Entity Type:Organization
Organization Name:JOEL P MILLER DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:L
Authorized Official - Last Name:ORR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-824-3913
Mailing Address - Street 1:3998 RED LION RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-1436
Mailing Address - Country:US
Mailing Address - Phone:215-824-2859
Mailing Address - Fax:215-824-3963
Practice Address - Street 1:3998 RED LION RD
Practice Address - Street 2:SUITE 209
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1436
Practice Address - Country:US
Practice Address - Phone:215-824-2859
Practice Address - Fax:215-824-3963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003385L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018212320001Medicaid
PA0286989000OtherKEYSTONE HMO GROUP NUMBER
PA091359OtherBLUE SHIELD GROUP NUMBER
PA1001272OtherKEYSTONE MERCY GROUP NUMB
PA30571OtherHEALTH PARTNERS
PA30571OtherSENIOR PARTNERS
PA0018212320001Medicaid