Doctor Name: | DR. DEREK MATTHEW MILETICH |
NPI Number: | 1033291059 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 39020000X |
Business Practice Address: | 620 John Paul Jones Cir Portsmouth, VA - 237082111 |
Business Phone Number: | 7579535000 |
Business Fax Number: | |
Mailing Address: | 111 High St, Suite 406 PORTSMOUTH |
State: | VA |
Postal Code: | 237043845 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 10/19/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 39020000X |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |