Provider Demographics
NPI:1235194242
Name:DRAKE, CHARLES R JR (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:R
Last Name:DRAKE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1829 W. PLAZA DRIVE
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-6365
Mailing Address - Country:US
Mailing Address - Phone:540-667-6161
Mailing Address - Fax:540-722-2744
Practice Address - Street 1:1829 W. PLAZA DRIVE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-6365
Practice Address - Country:US
Practice Address - Phone:540-667-6161
Practice Address - Fax:540-722-2744
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101035745207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006041647Medicaid
110028381OtherMEDICARE RR
VA1725296502Medicaid
110028381OtherMEDICARE RR
VA1725296502Medicaid