Provider Demographics
NPI:1083696280
Name:MILLER, DAVID T (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:T
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 N UNION RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5383
Mailing Address - Country:US
Mailing Address - Phone:716-636-1470
Mailing Address - Fax:716-636-1423
Practice Address - Street 1:8750 TRANSIT RD
Practice Address - Street 2:SUITE 105
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051-2610
Practice Address - Country:US
Practice Address - Phone:716-636-1470
Practice Address - Fax:888-886-2563
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208251174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH40420Medicare UPIN
NYCC6668Medicare ID - Type UnspecifiedMEDICARE #