Provider Demographics
NPI:1861473324
Name:MILLER, CRAIG CAMERON (MD PHD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:CAMERON
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5320 MILITARY RD STE 104
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:NY
Mailing Address - Zip Code:14092-2149
Mailing Address - Country:US
Mailing Address - Phone:716-205-8324
Mailing Address - Fax:716-205-8593
Practice Address - Street 1:5320 MILITARY RD
Practice Address - Street 2:STE 104
Practice Address - City:LEWISTON
Practice Address - State:NY
Practice Address - Zip Code:14092-2149
Practice Address - Country:US
Practice Address - Phone:716-205-8324
Practice Address - Fax:716-205-8593
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211871207N00000X, 207ND0101X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01981268Medicaid
NY01981268Medicaid
NYJ400048299Medicare PIN