Provider Demographics
NPI:1376591875
Name:MILLER, DONALD (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
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:L-3549
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43260-0001
Mailing Address - Country:US
Mailing Address - Phone:740-383-7927
Mailing Address - Fax:740-383-7942
Practice Address - Street 1:1050 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6416
Practice Address - Country:US
Practice Address - Phone:740-383-8063
Practice Address - Fax:740-387-7019
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35038734M2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1600271OtherUHC
300029085OtherTRAVELERS MEDICARE
311098079OtherTAX ID
643273OtherAETNA
0639661OtherPALMETTO MEDICARE
311098079OtherPPO NEXT
353077OtherSUBMITTER NO
311098079249OtherMEDICAL MUTUAL
OH0363244Medicaid
311098079014OtherCIGNA
OH000000323806OtherANTHEM
OH31109807913OtherWORKERS COMP
31109807913OtherWORKERS COMPENSATION
300029085OtherTRAVELERS MEDICARE
OH0639661Medicare ID - Type Unspecified
353077OtherSUBMITTER NO