Provider Demographics
NPI:1538397294
Name:MILLER, MAUREEN CLARKE (MD)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:CLARKE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:MARGARET
Other - Last Name:CLARKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2450 W HUNTING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1302
Mailing Address - Country:US
Mailing Address - Phone:215-707-1800
Mailing Address - Fax:215-707-3644
Practice Address - Street 1:1316 W ONTARIO ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5220
Practice Address - Country:US
Practice Address - Phone:215-707-1800
Practice Address - Fax:215-707-3644
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT196079207R00000X
PAMD445830207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine