Provider Demographics
NPI:1417908310
Name:MILLER, JAY KENNETH (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:KENNETH
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:471 HEPBURN ST
Mailing Address - Street 2:COMMUNITY HEALTH CENTER
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-6122
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:471 HEPBURN ST
Practice Address - Street 2:COMMUNITY HEALTH CENTER
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-6122
Practice Address - Country:US
Practice Address - Phone:570-567-5400
Practice Address - Fax:570-567-5421
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022262E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA040026Medicare ID - Type Unspecified
C28386Medicare UPIN