Healthcare Provider Details

I. General information

NPI: 1922079219
Provider Name (Legal Business Name): DONALD MILLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 07/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 WARREN ST
LOWELL MA
01852-2216
US

IV. Provider business mailing address

161 JACKSON ST
LOWELL MA
01852-2103
US

V. Phone/Fax

Practice location:
  • Phone: 978-322-8500
  • Fax: 978-446-0248
Mailing address:
  • Phone: 978-937-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number49826
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: