Individual
MR. RUSSELL J MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA C
Contact information
Practice address
1468 TREVORTON RD, COAL TOWNSHIP, PA 17866-7725
(570) 648-9769
(717) 692-2381
Mailing address
1468 TREVORTON RD, COAL TOWNSHIP, PA 17866-7725
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
MA 001072 L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA 001072 L
STATE LICENSE #
PA
Enumeration date
04/03/2006
Last updated
06/30/2016
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