Provider Demographics
NPI:1376802884
Name:MILLER, BRETT
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 LOWER STATE RD BLDG 200
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-2622
Mailing Address - Country:US
Mailing Address - Phone:215-345-6647
Mailing Address - Fax:215-345-0460
Practice Address - Street 1:2003 LOWER STATE RD BLDG 200
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-2622
Practice Address - Country:US
Practice Address - Phone:215-345-6647
Practice Address - Fax:215-345-0460
Is Sole Proprietor?:No
Enumeration Date:2012-05-04
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD461130207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery