Provider Demographics
NPI:1407957194
Name:MILLER, RONALD K (RPA-C)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:K
Last Name:MILLER
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:33 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14105-1040
Mailing Address - Country:US
Mailing Address - Phone:716-735-3735
Mailing Address - Fax:716-735-3036
Practice Address - Street 1:21 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLEPORT
Practice Address - State:NY
Practice Address - Zip Code:14105-1027
Practice Address - Country:US
Practice Address - Phone:716-735-7774
Practice Address - Fax:716-735-3036
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002767-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYD01575Medicare UPIN