Provider Demographics
NPI:1891085916
Name:MILLER, JENNIFER EARLE (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:EARLE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:EARLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:300 1ST AVE
Mailing Address - Street 2:DEPARTMENT OF PHYSICAL MEDICINE AND REHABILITATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-3109
Mailing Address - Country:US
Mailing Address - Phone:518-727-2497
Mailing Address - Fax:
Practice Address - Street 1:300 1ST AVE
Practice Address - Street 2:DEPARTMENT OF PHYSICAL MEDICINE AND REHABILITATION
Practice Address - City:CHARLESTOWN
Practice Address - State:MA
Practice Address - Zip Code:02129-3109
Practice Address - Country:US
Practice Address - Phone:518-727-2497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA251268208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation