Provider Demographics
NPI:1659341436
Name:MILLER, DONALD W (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:W
Last Name:MILLER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-2663
Mailing Address - Fax:614-293-2053
Practice Address - Street 1:543 TAYLOR AVE FL 1
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43203-1278
Practice Address - Country:US
Practice Address - Phone:614-293-2663
Practice Address - Fax:614-293-2053
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.001389RX363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPA 23652OtherMEDICARE PTAN
OHQ26406Medicare UPIN
OHPA23652Medicare PIN
OHPA 23652OtherMEDICARE PTAN
OHMIPA23655Medicare PIN