Provider Demographics
NPI:1891763355
Name:MILLER, EDWARD J (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:J
Last Name:MILLER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:7629 MARKET ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-6075
Mailing Address - Country:US
Mailing Address - Phone:330-965-4540
Mailing Address - Fax:330-965-4559
Practice Address - Street 1:7641 MARKET ST
Practice Address - Street 2:SUITE 2
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-6010
Practice Address - Country:US
Practice Address - Phone:330-884-2444
Practice Address - Fax:330-965-4836
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2015-04-14
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Provider Licenses
StateLicense IDTaxonomies
OH35069170207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2110003Medicaid
OH2110003Medicaid