Provider Demographics
NPI:1396737458
Name:MILES, GEORGE BRUCE (DO)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:BRUCE
Last Name:MILES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:G.
Other - Middle Name:BRUCE
Other - Last Name:MILES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:3101 EMRICK BLVD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-8037
Mailing Address - Country:US
Mailing Address - Phone:484-822-5570
Mailing Address - Fax:484-822-5604
Practice Address - Street 1:3101 EMRICK BLVD
Practice Address - Street 2:SUITE 112
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-8037
Practice Address - Country:US
Practice Address - Phone:610-419-6426
Practice Address - Fax:610-419-6427
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS002988L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA124222OtherHIGHMARK PIN
PA0007792600004Medicaid
PA124222V8GMedicare PIN
C30880Medicare UPIN
PA0007792600004Medicaid