Provider Demographics
NPI:1134127384
Name:MILLER, PETER ANDREW (DPM)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:ANDREW
Last Name:MILLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 COURT ST
Mailing Address - Street 2:P.O. BOX 586
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753-1419
Mailing Address - Country:US
Mailing Address - Phone:802-388-1200
Mailing Address - Fax:802-388-3566
Practice Address - Street 1:76 COURT ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-1419
Practice Address - Country:US
Practice Address - Phone:802-388-1200
Practice Address - Fax:802-388-3566
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2007-07-09
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-21
Provider Licenses
StateLicense IDTaxonomies
VT056-0000150213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0VN2229Medicaid
VT0VN0544Medicaid
VTVN2229Medicare ID - Type UnspecifiedGROUP NUMBER
VTVN0544Medicare ID - Type Unspecified
VT0VN2229Medicaid