Provider Demographics
NPI:1922638642
Name:MILLER, TOM ROOT II (MD)
Entity Type:Individual
Prefix:
First Name:TOM
Middle Name:ROOT
Last Name:MILLER
Suffix:II
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 1:35 NIAGARA PIER
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-2312
Mailing Address - Country:US
Mailing Address - Phone:814-452-0068
Mailing Address - Fax:814-452-0068
Practice Address - Street 1:35 NIAGARA PIER
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-2312
Practice Address - Country:US
Practice Address - Phone:814-452-0068
Practice Address - Fax:814-452-0068
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD005558E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine