Provider Demographics
NPI:1750732889
Name:MILLER, CORY (PA)
Entity type:Individual
Prefix:
First Name:CORY
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:PO BOX 727
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04903-0727
Mailing Address - Country:US
Mailing Address - Phone:207-897-4345
Mailing Address - Fax:207-897-2321
Practice Address - Street 1:16 DEPOT ST
Practice Address - Street 2:
Practice Address - City:LIVERMORE FALLS
Practice Address - State:ME
Practice Address - Zip Code:04254-1311
Practice Address - Country:US
Practice Address - Phone:207-897-4345
Practice Address - Fax:207-897-2321
Is Sole Proprietor?:No
Enumeration Date:2016-06-30
Last Update Date:2023-06-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MEPA1622363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant