Provider Demographics
NPI:1710392774
Name:MILLER, THERESA M (MD)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:M
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 E 14TH ST
Mailing Address - Street 2:APT 8B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-3231
Mailing Address - Country:US
Mailing Address - Phone:347-256-7868
Mailing Address - Fax:
Practice Address - Street 1:5750 MOSHOLU AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-2206
Practice Address - Country:US
Practice Address - Phone:718-601-0627
Practice Address - Fax:718-601-0367
Is Sole Proprietor?:No
Enumeration Date:2014-06-27
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-10076207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine