Provider Demographics
NPI:1306848684
Name:MILLER, JOEL PAUL (DO)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:PAUL
Last Name:MILLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3998 RED LION ROAD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-1440
Mailing Address - Country:US
Mailing Address - Phone:215-824-3913
Mailing Address - Fax:215-824-3963
Practice Address - Street 1:3998 RED LION ROAD
Practice Address - Street 2:SUITE 207
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1440
Practice Address - Country:US
Practice Address - Phone:215-824-2859
Practice Address - Fax:215-824-3963
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003385L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1001272Medicaid
PA2576OtherAETNA US HEALTHCARE
PA0055022000OtherKEYSTONE
PA635450OtherBLUE SHIELD
PA1052527002OtherCIGNA
PA0182123200010Medicaid
PA0182123200010Medicaid
PA635450Medicare ID - Type Unspecified