Provider Demographics
NPI:1780641001
Name:MILLER, DANIELLE M (MD)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:M
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 MALL RD.
Mailing Address - Street 2:LAHEY CLINIC, INC.
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805-0001
Mailing Address - Country:US
Mailing Address - Phone:781-744-8771
Mailing Address - Fax:781-744-2905
Practice Address - Street 1:41 MALL RD.
Practice Address - Street 2:LAHEY CLINIC
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01805-0001
Practice Address - Country:US
Practice Address - Phone:781-744-8443
Practice Address - Fax:781-744-5687
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA205624207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0131351Medicaid
MA0131351Medicaid
MAA3157503Medicare PIN