Provider Demographics
NPI:1619009099
Name:MIELE, BEVON DAVID (MD)
Entity Type:Individual
Prefix:
First Name:BEVON
Middle Name:DAVID
Last Name:MIELE
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 1:2 KINGS CT
Mailing Address - Street 2:SUITE 207
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-6019
Mailing Address - Country:US
Mailing Address - Phone:908-806-4466
Mailing Address - Fax:908-806-3553
Practice Address - Street 1:2 KINGS CT
Practice Address - Street 2:SUITE 207
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-6019
Practice Address - Country:US
Practice Address - Phone:908-806-4466
Practice Address - Fax:908-806-3553
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ47091207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD97089Medicare UPIN
NJ565524Medicare ID - Type UnspecifiedPROVIDER NUMBER