Provider Demographics
NPI:1225458003
Name:MCMILLAN, NATASHA
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187-27 DUNKIRK DR
Mailing Address - Street 2:
Mailing Address - City:ST. ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412
Mailing Address - Country:US
Mailing Address - Phone:347-749-0321
Mailing Address - Fax:
Practice Address - Street 1:187-27 DUNKIRK DR
Practice Address - Street 2:
Practice Address - City:ST. ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412
Practice Address - Country:US
Practice Address - Phone:718-276-5458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-21
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY290617207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology