Provider Demographics
NPI:1174695225
Name:LOTA, MILES JAN (DO)
Entity type:Individual
Prefix:DR
First Name:MILES
Middle Name:JAN
Last Name:LOTA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 KENMORE LN
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-2078
Mailing Address - Country:US
Mailing Address - Phone:607-349-8680
Mailing Address - Fax:215-748-9685
Practice Address - Street 1:501 S 54TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-1900
Practice Address - Country:US
Practice Address - Phone:215-748-9490
Practice Address - Fax:215-748-9685
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210013207R00000X
FLOS10751207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01816655Medicaid
NY01816655Medicaid
FLCH470ZMedicare PIN
NYG68431Medicare UPIN