Provider Demographics
NPI:1932101961
Name:MILLER, ERIC (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
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 1:2 EVES DR
Mailing Address - Street 2:SUITE 109
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3193
Mailing Address - Country:US
Mailing Address - Phone:856-669-6061
Mailing Address - Fax:856-651-0853
Practice Address - Street 1:668 MAIN ST
Practice Address - Street 2:STE 4
Practice Address - City:LUMBERTON
Practice Address - State:NJ
Practice Address - Zip Code:08048-5016
Practice Address - Country:US
Practice Address - Phone:609-267-7050
Practice Address - Fax:609-267-7065
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05474600208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5646201Medicaid
004085Medicare PIN