Provider Demographics
NPI:1336272822
Name:MILLER, DOLORES ANN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:DOLORES
Middle Name:ANN
Last Name:MILLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2647 BROWNSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-3203
Mailing Address - Country:US
Mailing Address - Phone:267-568-2245
Mailing Address - Fax:
Practice Address - Street 1:9600 ROOSEVELT BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-3932
Practice Address - Country:US
Practice Address - Phone:215-677-9870
Practice Address - Fax:215-677-0977
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA050823363AM0700X
PAOA000814363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical