Provider Demographics
NPI:1265572093
Name:MILLER, MARK ANDREW (DO)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANDREW
Last Name:MILLER
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 TECHNOLOGY PKWY STE 3100
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-9426
Mailing Address - Country:US
Mailing Address - Phone:717-221-5940
Mailing Address - Fax:717-233-1939
Practice Address - Street 1:2020 TECHNOLOGY PKWY STE 3100
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-9426
Practice Address - Country:US
Practice Address - Phone:717-221-5940
Practice Address - Fax:717-233-1939
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS014115207VX0201X, 207V00000X
VA0102201618207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2092940OtherHIGHMARK BLUE SHIELD
PA102281266Medicaid
PA102281226Medicaid
PA147812Medicare PIN
PA102281226Medicaid