Provider Demographics
NPI:1346220944
Name:MILLER, CAMILLE A (PA-C, MPAS)
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:A
Last Name:MILLER
Suffix:
Gender:F
Credentials:PA-C, MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 TECH PARK DR
Mailing Address - Street 2:SUITE 1120
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15901-2515
Mailing Address - Country:US
Mailing Address - Phone:814-475-8700
Mailing Address - Fax:814-475-8754
Practice Address - Street 1:1086 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-4305
Practice Address - Country:US
Practice Address - Phone:814-410-8300
Practice Address - Fax:814-410-8331
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA003357L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P63006Medicare UPIN
PA175976Medicare PIN
PA239832Medicare PIN