Healthcare Provider Details

I. General information

NPI: 1992874911
Provider Name (Legal Business Name): MICHAEL TRAFFORD DARST DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 11/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 HAMMOND LANE
PLATTSBURGH NY
12901
US

IV. Provider business mailing address

91 HAMMOND LANE
PLATTSBURGH NY
12901
US

V. Phone/Fax

Practice location:
  • Phone: 518-562-5600
  • Fax: 518-562-9211
Mailing address:
  • Phone: 518-562-5600
  • Fax: 518-562-9211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN0053771
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: