Provider Demographics
NPI:1922079219
Name:MILLER, DONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:
Last Name:MILLER
Suffix:
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 1:161 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-2103
Mailing Address - Country:US
Mailing Address - Phone:978-937-9700
Mailing Address - Fax:
Practice Address - Street 1:17 WARREN ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-2216
Practice Address - Country:US
Practice Address - Phone:978-322-8500
Practice Address - Fax:978-446-0248
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA49826207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9763473Medicaid
MAJO4667Medicare ID - Type Unspecified
MAB97873Medicare UPIN