Provider Demographics
NPI:1336253525
Name:MILLER, JEROME (DO)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 TOWER LN
Mailing Address - Street 2:
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072-1128
Mailing Address - Country:US
Mailing Address - Phone:610-667-6889
Mailing Address - Fax:610-667-0630
Practice Address - Street 1:216 TOWER LN
Practice Address - Street 2:
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072-1128
Practice Address - Country:US
Practice Address - Phone:610-667-6889
Practice Address - Fax:610-667-0630
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOSOO2094L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAD66308Medicare UPIN