1174697346 NPI number — DR. GLENN MILLER M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174697346 NPI number — DR. GLENN MILLER M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

MILLER

Provider First Name:

GLENN

Provider Middle Name:

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1174697346

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/08/2007

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

3831 RAMAGE RUN

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

HUNTINGDON VALLEY

Provider Business Mailing Address State Name:

PA

Provider Business Mailing Address Postal Code:

19006-2453

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

215-938-0254

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

2410 S BROAD ST

Provider Second Line Business Practice Location Address:

3RD FLR

Provider Business Practice Location Address City Name:

PHILADELPHIA

Provider Business Practice Location Address State Name:

PA

Provider Business Practice Location Address Postal Code:

19145-4418

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

215-462-6600

Provider Business Practice Location Address Fax Number:

215-462-2650

Provider Enumeration Date:

11/20/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207LP2900X , with the licence number:  MD033553E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 20033920 . This is a "AMERIHEALTH MERCY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 050088759 . This is a "RR MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 30003770 . This is a "HORIZON NJ HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 011223020 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 517607 . This is a "AMERIHEALTH ADMINISTRATOR" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 0112230205 . This is a "ALL IBC PRODUCTS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 3039 . This is a "BRAVO BY ELDER HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 517607 . This is a "ALL BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 0111120000 . This is a "AMERIHEALTH PC & HMO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 2992866 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 30003770 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".