Provider Demographics
NPI:1417946229
Name:MILLER, SAMUEL R (DPM)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:R
Last Name:MILLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 BERKSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1219
Mailing Address - Country:US
Mailing Address - Phone:610-373-4154
Mailing Address - Fax:610-393-8651
Practice Address - Street 1:50 BERKSHIRE CT
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1219
Practice Address - Country:US
Practice Address - Phone:610-373-4154
Practice Address - Fax:610-393-8651
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001478L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000505185001Medicaid
PASC001478LOtherMEDICAL LICENSE
PA045379001OtherDME
PAT78228Medicare UPIN
PA148004HP6Medicare PIN