Provider Demographics
NPI:1447337183
Name:MILLER, LAWRENCE S (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:S
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 1:1 FEDERAL ST # 200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:856-356-4924
Mailing Address - Fax:
Practice Address - Street 1:221 VICTORIA ST
Practice Address - Street 2:
Practice Address - City:GLASSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08028-2278
Practice Address - Country:US
Practice Address - Phone:856-536-1475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA74564207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2130421000OtherAMERIHEALTH/KEYSTON/IBC
PA0052412000OtherKEYSTONE/IBC
NJ010004388OtherAMERICHOICE
NJ2937750OtherAETNA
NJ42384OtherUNIVERSITY HEALTH PLAN
NJ8939403Medicaid
NJ3K5446OtherHEALTHNET
NJ1447021OtherAMERIHEALTH PPO/BLUE SHIELD
NJ1072456OtherCIGNA
NJ426719OtherUNITED HEALTHCARE
NJP395850OtherOXFORD
NJ426719OtherUNITED HEALTHCARE
NJP395850OtherOXFORD
C32723Medicare UPIN