Provider Demographics
NPI:1194785436
Name:MILLER, MYRON D (MD)
Entity type:Individual
Prefix:DR
First Name:MYRON
Middle Name:D
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:120 S TAN ALY STE 1
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17026-9349
Mailing Address - Country:US
Mailing Address - Phone:717-865-6644
Mailing Address - Fax:717-865-5666
Practice Address - Street 1:120 S. TAN ST., SUITE1
Practice Address - Street 2:FREDERICKSBURG COMMUNITY HEALTH CENTER, P.C.
Practice Address - City:FREDERICKSBURG
Practice Address - State:PA
Practice Address - Zip Code:17026-0009
Practice Address - Country:US
Practice Address - Phone:717-865-6644
Practice Address - Fax:717-865-7321
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039873E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01985401OtherBLUE CROSS
PA001232180Medicaid
PA0630043OtherBLUE SHIELD
PA01985401OtherBLUE CROSS
E59067Medicare UPIN