1396864435 NPI number — MR. GARY M MILLER M.S.W., L.S.W.

Table of content: MR. GARY M MILLER M.S.W., L.S.W. (NPI 1396864435)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396864435 NPI number — MR. GARY M MILLER M.S.W., L.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
GARY
Provider Middle Name:
M
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.S.W., L.S.W.
Provider Gender Code:
M

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:
1396864435
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3210 CHRISTIANA MDWS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEAR
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19701-2863
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-325-2169
Provider Business Mailing Address Fax Number:
215-849-0500

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
211 N MONROE ST
Provider Second Line Business Practice Location Address:
SECOND FLOOR
Provider Business Practice Location Address City Name:
MEDIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19063-3019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-325-2169
Provider Business Practice Location Address Fax Number:
215-849-0500
Provider Enumeration Date:
03/28/2007

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: 1041C0700X , with the licence number:  SW000982E , 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)





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