Provider Demographics
NPI:1124143359
Name:MILLER, STEPHEN WAYNE (PA-C)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:WAYNE
Last Name:MILLER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 HIDDEN CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-8451
Mailing Address - Country:US
Mailing Address - Phone:207-885-5807
Mailing Address - Fax:
Practice Address - Street 1:50 SEWALL ST
Practice Address - Street 2:SUITE 301
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2645
Practice Address - Country:US
Practice Address - Phone:207-780-6631
Practice Address - Fax:207-780-6320
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA-042363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical