Healthcare Provider Details

I. General information

NPI: 1255266052
Provider Name (Legal Business Name): TICKORTREAT MEDICAL PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 PEAKED MOUNTAIN RD
TOWNSHEND VT
05353-8810
US

IV. Provider business mailing address

PO BOX 344
TOWNSHEND VT
05353-0344
US

V. Phone/Fax

Practice location:
  • Phone: 802-380-2501
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MAXWELL DANIEL MILLER
Title or Position: PRESIDENT
Credential: MD
Phone: 802-380-2501