Provider Demographics
NPI:1104834704
Name:DRUCKER, BEVERLY J (MD)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:J
Last Name:DRUCKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 LAFAYETTE PL
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-5426
Mailing Address - Country:US
Mailing Address - Phone:203-863-3737
Mailing Address - Fax:203-863-3741
Practice Address - Street 1:77 LAFAYETTE PL
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-5426
Practice Address - Country:US
Practice Address - Phone:203-863-3737
Practice Address - Fax:203-863-3741
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT042997207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G53514Medicare UPIN