Provider Demographics
NPI:1407861925
Name:LAWRENCE I. MILLER, D.O., P.C.
Entity type:Organization
Organization Name:LAWRENCE I. MILLER, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:IAN
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-412-4910
Mailing Address - Street 1:2031 N BROAD ST
Mailing Address - Street 2:SUITE 121
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-1063
Mailing Address - Country:US
Mailing Address - Phone:215-412-4910
Mailing Address - Fax:215-412-4911
Practice Address - Street 1:2031 N BROAD ST
Practice Address - Street 2:SUITE 121
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-1063
Practice Address - Country:US
Practice Address - Phone:215-412-4910
Practice Address - Fax:215-412-4911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG90508Medicare UPIN