Provider Demographics
NPI:1992709968
Name:MILLER, GERARD A (MD)
Entity type:Individual
Prefix:
First Name:GERARD
Middle Name:A
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 DARBY RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-4639
Mailing Address - Country:US
Mailing Address - Phone:610-789-7600
Mailing Address - Fax:610-449-1287
Practice Address - Street 1:510 DARBY RD
Practice Address - Street 2:SUITE 203
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-4639
Practice Address - Country:US
Practice Address - Phone:610-789-7600
Practice Address - Fax:610-449-1287
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD040653E207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE52833Medicare UPIN
PA466173K9LMedicare PIN