Provider Demographics
NPI:1962488916
Name:MILLER, GERALD E (MD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:E
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 1:1159 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:PA
Mailing Address - Zip Code:17547-1628
Mailing Address - Country:US
Mailing Address - Phone:717-426-1131
Mailing Address - Fax:717-426-2068
Practice Address - Street 1:1159 RIVER RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:PA
Practice Address - Zip Code:17547-1628
Practice Address - Country:US
Practice Address - Phone:717-426-1131
Practice Address - Fax:717-426-2068
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019845E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA007751OtherHIGHMARK BLUE SHIELD
PAP002638OtherGATEWAY HEALTH PLAN
PA34994 S1QKOtherGEISINGER HEALTH PLAN
PA5502498OtherAETNA NON-HMO
PA0006954000001Medicaid
PA01332001OtherCAPITAL BLUE CROSS
PA535943OtherAETNA HMO
PAC30214OtherHEALTH ASSURANCE
PA535943OtherAETNA HMO
PA007751HE1Medicare PIN