Provider Demographics
NPI:1992874911
Name:DARST, MICHAEL TRAFFORD (DPM)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:TRAFFORD
Last Name:DARST
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 HAMMOND LANE
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901
Mailing Address - Country:US
Mailing Address - Phone:518-562-5600
Mailing Address - Fax:518-562-9211
Practice Address - Street 1:91 HAMMOND LANE
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901
Practice Address - Country:US
Practice Address - Phone:518-562-5600
Practice Address - Fax:518-562-9211
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0053771213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DD0247Medicare ID - Type Unspecified
U66106Medicare UPIN