Individual
WALLACE MILLER JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3400 SPRUCE ST, GROUND FLOOR DULLES, PHILADELPHIA, PA 19104
(215) 662-3000
(215) 662-7011
Mailing address
3400 SPRUCE ST, GROUND FLOOR DULLES, PHILADELPHIA, PA 19104-4206
(215) 662-3000
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MD039219E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0012316660011
—
PA
Enumeration date
06/29/2006
Last updated
01/19/2016
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