1043272289 NPI number — DR. DOREEN EDITH MILLER MD

Table of content: DR. DOREEN EDITH MILLER MD (NPI 1043272289)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043272289 NPI number — DR. DOREEN EDITH MILLER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
DOREEN
Provider Middle Name:
EDITH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

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 Information

NPI Number:
1043272289
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9
Provider Second Line Business Mailing Address:
FREDERICKSBURG COMMUNITY HEALTH CENTER PC
Provider Business Mailing Address City Name:
FREDERICKSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17026-0009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-865-6644
Provider Business Mailing Address Fax Number:
717-865-7321

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 S TAN STREET, SUITE 1
Provider Second Line Business Practice Location Address:
FREDERICKSBURG COMMUNITY HEALTH CENTER PC
Provider Business Practice Location Address City Name:
FREDERICKSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17026-9349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-865-6644
Provider Business Practice Location Address Fax Number:
717-865-7321
Provider Enumeration Date:
04/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MD039867E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 50053494 . This is a "BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 001789162 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 713415 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com