Provider Demographics
NPI:1710986831
Name:MILLER, JED LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:JED
Middle Name:LEE
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 1:2675 JOPPA RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-5160
Mailing Address - Country:US
Mailing Address - Phone:717-741-9063
Mailing Address - Fax:717-741-3634
Practice Address - Street 1:2675 JOPPA RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-5160
Practice Address - Country:US
Practice Address - Phone:717-741-9063
Practice Address - Fax:717-741-3634
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD423709208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1010332050001Medicaid
I08220Medicare UPIN