Provider Demographics
NPI:1548029762
Name:BURT-MILLER, JOEL FREDERICK
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:FREDERICK
Last Name:BURT-MILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 GROVE RD UNIT A
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4209
Mailing Address - Country:US
Mailing Address - Phone:347-291-7995
Mailing Address - Fax:
Practice Address - Street 1:801 MASSACHUSETTS AVE STE 470
Practice Address - Street 2:C/O ERIN OREILLY
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2605
Practice Address - Country:US
Practice Address - Phone:617-638-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program