Provider Demographics
NPI:1902865942
Name:MCCAUGHAN, DIA D (DPM)
Entity Type:Individual
Prefix:DR
First Name:DIA
Middle Name:D
Last Name:MCCAUGHAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:DIA
Other - Middle Name:D
Other - Last Name:MILLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:104 FITE WAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:QUARRYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17566-9395
Mailing Address - Country:US
Mailing Address - Phone:717-786-8896
Mailing Address - Fax:717-786-8367
Practice Address - Street 1:104 FITE WAY
Practice Address - Street 2:SUITE B
Practice Address - City:QUARRYVILLE
Practice Address - State:PA
Practice Address - Zip Code:17566-9395
Practice Address - Country:US
Practice Address - Phone:717-786-8896
Practice Address - Fax:717-786-8367
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC653213ES0103X
DEE1-0000158213E00000X
PASC-004722-L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU84101Medicare UPIN
PA045699Medicare ID - Type UnspecifiedMEDICARE IND. ID#