Provider Demographics
NPI:1093714578
Name:DRAKE, DAVID WILLIAM (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WILLIAM
Last Name:DRAKE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 SOUTHEAST BLVD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44460-3464
Mailing Address - Country:US
Mailing Address - Phone:330-332-1939
Mailing Address - Fax:330-332-2233
Practice Address - Street 1:2094 E. STATE STREET
Practice Address - Street 2:SUITE B
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460
Practice Address - Country:US
Practice Address - Phone:330-332-1939
Practice Address - Fax:330-332-2233
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-2537D207V00000X
OH34-00-2537-D207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0348556Medicaid
H152110Medicare PIN
215531OtherUPMC
341931777OtherCARELINK HEALTH PLAN
3820453OtherCIGNA/HEALTHSOURCE
341931777OtherHEALTH ASSURANCE/HE
341931777DDOtherSUMMA CARE
341931777AOtherAULTCARE
WELFARE CLASSOther0348556
07-01064OtherUHC
0438472Medicare ID - Type Unspecified
160056652Medicare ID - Type UnspecifiedRAILROAD
OH0348556Medicaid
000000179627OtherANTHEM
DR056898OtherHIGHMARK
A76381Medicare UPIN
OHA76381Medicare UPIN