Provider Demographics
NPI:1275713042
Name:MILES, LIESL CAREY (MD)
Entity Type:Individual
Prefix:DR
First Name:LIESL
Middle Name:CAREY
Last Name:MILES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:301 LIPPINCOTT DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:856-291-8650
Mailing Address - Fax:856-291-8654
Practice Address - Street 1:401 YOUNG AVE STE 380A
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3130
Practice Address - Country:US
Practice Address - Phone:856-291-8650
Practice Address - Fax:856-291-8654
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-09
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09089200207R00000X
NJ25MA09087200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty