Individual
JONATHAN MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
164 SUMMIT AVE, PROVIDENCE, RI 02906-2853
(401) 793-4480
Mailing address
125 METRO CENTER BLVD STE 2000, WARWICK, RI 02886-1785
(401) 432-2500
(401) 921-9212
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA01059
RI
363AS0400X
Surgical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA01059
RHODE ISLAND PA LICENSE
RI
01
—
PA8635
MASSACHUSETTS PA LICENSE
MA
Enumeration date
06/14/2018
Last updated
05/26/2022
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