Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD051280L | PA |
Y | 2080P0214X | Pediatric Pulmonologist | MD051280L | PA |
NPI | 1326061367 |
---|---|
Provider Name | Robert W Miller |
First Address | Philadelphia, PA 19107-3323 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 17/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001445528 | (05) | PA |
6362401 | (05) | NJ |
F73506 | (02) |