Provider Demographics
NPI:1033119870
Name:MILLER, WAYNE (DO)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 W GERMANTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19403-3905
Mailing Address - Country:US
Mailing Address - Phone:610-539-8500
Mailing Address - Fax:610-539-0910
Practice Address - Street 1:2601 HOLME AVE FL 3
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-2096
Practice Address - Country:US
Practice Address - Phone:215-335-6028
Practice Address - Fax:267-350-7441
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2022-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005935L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011943750003Medicaid
PA0011943750003Medicaid
PAP00095257Medicare PIN
PA437544R64Medicare PIN