Provider Demographics
NPI:1972512739
Name:MILLER, JONATHAN A (DPM)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:A
Last Name:MILLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 MEETING HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHATHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02659-1400
Mailing Address - Country:US
Mailing Address - Phone:508-432-7100
Mailing Address - Fax:508-432-7101
Practice Address - Street 1:31 MEETING HOUSE RD
Practice Address - Street 2:
Practice Address - City:SOUTH CHATHAM
Practice Address - State:MA
Practice Address - Zip Code:02659-1400
Practice Address - Country:US
Practice Address - Phone:508-432-7100
Practice Address - Fax:508-432-7101
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 2808213E00000X
MA2142213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1972512739OtherTUFTS
1972512739OtherBMC HEALTHNET
MAAA117209OtherHARVARD PILGRIM
MA0000Y71148OtherBCBS
MAAA117209OtherHARVARD PILGRIM
MA6490600001Medicare NSC