1316925274 NPI number — DR. DONALD BARKER MILLER MD

Table of content: DR. DONALD BARKER MILLER MD (NPI 1316925274)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316925274 NPI number — DR. DONALD BARKER MILLER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
DONALD
Provider Middle Name:
BARKER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MILLER
Provider Other First Name:
DONALD
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1316925274
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 749
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORRISVILLE
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05661-0749
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-851-8619
Provider Business Mailing Address Fax Number:
802-851-8716

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
272 N MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
CAMBRIDGE
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05444-9810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-644-5114
Provider Business Practice Location Address Fax Number:
802-888-6075
Provider Enumeration Date:
01/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  0420005252 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0420005252 . This is a "STATE LICENSE" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 0004599 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".




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