Provider Demographics
NPI:1437137908
Name:DR. GERALD MILEY
Entity Type:Organization
Organization Name:DR. GERALD MILEY
Other - Org Name:DR. GERALD MILEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:GERLAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-738-9600
Mailing Address - Street 1:125 PARKER HILL AVE
Mailing Address - Street 2:FOGG BLDG SUITE 308
Mailing Address - City:ROXBURY CROSSING
Mailing Address - State:MA
Mailing Address - Zip Code:02120-2847
Mailing Address - Country:US
Mailing Address - Phone:617-738-9600
Mailing Address - Fax:
Practice Address - Street 1:125 PARKER HILL AVE
Practice Address - Street 2:FOGG BLDG SUITE 308
Practice Address - City:ROXBURY CROSSING
Practice Address - State:MA
Practice Address - Zip Code:02120-2847
Practice Address - Country:US
Practice Address - Phone:617-738-9600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA37761174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty