Provider Demographics
NPI:1659364255
Name:MILLER, KELLY PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:PATRICK
Last Name:MILLER
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 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-339-3165
Mailing Address - Fax:717-334-3140
Practice Address - Street 1:423 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-2526
Practice Address - Country:US
Practice Address - Phone:717-339-3165
Practice Address - Fax:717-334-3140
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045416L208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001593262Medicaid
PA849591Medicare PIN
PA001593262Medicaid
PAG23977Medicare UPIN