Provider Demographics
NPI:1134184286
Name:MILLER, DONALD L (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:L
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:PO BOX 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:843-777-5098
Mailing Address - Fax:843-777-7102
Practice Address - Street 1:10 E HOSPITAL ST
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102-3153
Practice Address - Country:US
Practice Address - Phone:803-435-5248
Practice Address - Fax:803-435-5288
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8179207P00000X, 207Q00000X
VA0101051303207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D90646Medicare UPIN
013141C23Medicare PIN
VA1134184286Medicaid
D90646Medicare UPIN
P00221512Medicare PIN
VA013141C23Medicare PIN
VA010144736Medicaid
VA010144078Medicaid