Provider Demographics
NPI:1225125784
Name:MILLER, JOHN W (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:169 RIVERSIDE DR
Mailing Address - Street 2:DEPAUL PAVILION
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-4246
Mailing Address - Country:US
Mailing Address - Phone:607-729-7666
Mailing Address - Fax:607-729-7667
Practice Address - Street 1:169 RIVERSIDE DR
Practice Address - Street 2:DEPAUL PAVILION
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-4246
Practice Address - Country:US
Practice Address - Phone:607-729-7666
Practice Address - Fax:607-729-7667
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2013-03-08
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Provider Licenses
StateLicense IDTaxonomies
NY189833-1208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF35751Medicare UPIN