Provider Demographics
NPI:1366458549
Name:MILLER, ANDREW LEVI (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:LEVI
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-3542
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2301 S BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-3542
Practice Address - Country:US
Practice Address - Phone:215-240-0875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD420663207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA20058876OtherAMERIHEALTH MERCY-WMG
PA1541162OtherGATEWAY-WMG
PA2125243000OtherAMERIHEALTH 65 PA
PA1441117OtherHIGHMARK BLUE SHIELD-WSMG
PA196194OtherUNISON-WMG
PA7661240OtherAETNA
MD014469000Medicaid
PA103831OtherGEISINGER
PA2161249OtherMAMSI-WMG
PA50064532OtherCAPITAL BLUE CROSS-(WSMG)
MD891089OtherCAREFIRST MD BCBS
PA101780123Medicaid
PA2161249OtherMAMSI-WMG
PA20058876OtherAMERIHEALTH MERCY-WMG
MD891089OtherCAREFIRST MD BCBS