Provider Demographics
NPI:1427032382
Name:MILLER, DARLA R (DPM)
Entity Type:Individual
Prefix:DR
First Name:DARLA
Middle Name:R
Last Name:MILLER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 N OLD TRL STE A
Mailing Address - Street 2:
Mailing Address - City:SHAMOKIN DAM
Mailing Address - State:PA
Mailing Address - Zip Code:17876-9428
Mailing Address - Country:US
Mailing Address - Phone:570-374-3668
Mailing Address - Fax:570-374-7306
Practice Address - Street 1:3120 N OLD TRL STE A
Practice Address - Street 2:
Practice Address - City:SHAMOKIN DAM
Practice Address - State:PA
Practice Address - Zip Code:17876-9428
Practice Address - Country:US
Practice Address - Phone:570-374-3668
Practice Address - Fax:570-374-7306
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004004L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015721370004Medicaid
PA828649WK6OtherMEDICARE ID
PA0015721370004Medicaid
PA828649WK6OtherMEDICARE ID