Provider Demographics
NPI:1972504199
Name:LADENHEIM, MILES (MD)
Entity Type:Individual
Prefix:
First Name:MILES
Middle Name:
Last Name:LADENHEIM
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 1:8& W GIRARD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-1708
Mailing Address - Country:US
Mailing Address - Phone:215-787-2000
Mailing Address - Fax:215-787-6990
Practice Address - Street 1:8& W GIRARD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-1708
Practice Address - Country:US
Practice Address - Phone:215-787-2000
Practice Address - Fax:215-787-6990
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041803E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA117012OtherCBH
F44400Medicare UPIN
PA415147HFHMedicare PIN