Provider Demographics
NPI:1649610858
Name:NIAGARA DERMATOLOGY ASSOCIATES LLC
Entity type:Organization
Organization Name:NIAGARA DERMATOLOGY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:CAMERON
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:716-205-8324
Mailing Address - Street 1:5320 MILITARY RD
Mailing Address - Street 2:STE 104
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-02
Last Update Date:2022-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211871207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty