Provider Demographics
NPI:1063979029
Name:MILLER, ELIZABETH PETRIKIN (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:PETRIKIN
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 GREENLAWN RD
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-2045
Mailing Address - Country:US
Mailing Address - Phone:610-639-1494
Mailing Address - Fax:
Practice Address - Street 1:1514 GREENLAWN RD
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-2045
Practice Address - Country:US
Practice Address - Phone:610-639-1494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4228482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry