Provider Demographics
NPI:1619914850
Name:MACMILLAN, DOUGLAS P JR (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:P
Last Name:MACMILLAN
Suffix:JR
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:PO BOX 1987
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-1987
Mailing Address - Country:US
Mailing Address - Phone:877-685-2164
Mailing Address - Fax:317-705-5060
Practice Address - Street 1:222 ASHELAND AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4016
Practice Address - Country:US
Practice Address - Phone:828-213-9090
Practice Address - Fax:828-213-9091
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-003212086S0129X
NC200600321208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC143M4OtherBCBS NC
NC5903741Medicaid
NC2054168BMedicare PIN
NC2054168Medicare PIN