Provider Demographics
NPI:1982664413
Name:MILTENBURG, DARLENE M (MD)
Entity type:Individual
Prefix:DR
First Name:DARLENE
Middle Name:M
Last Name:MILTENBURG
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 STATE ST STE 107
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1428
Mailing Address - Country:US
Mailing Address - Phone:814-877-3900
Mailing Address - Fax:814-877-3950
Practice Address - Street 1:300 STATE ST STE 107
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1428
Practice Address - Country:US
Practice Address - Phone:814-877-3900
Practice Address - Fax:814-877-3950
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6890208600000X
PAMD487207208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1175929-05Medicaid
TX8B7339OtherBLUE SHIELD
TX020050890OtherRR/MEDICARE
TX1175929-06OtherCSHCN
TX1175929-06OtherCSHCN
TX8802N4Medicare ID - Type Unspecified