Provider Demographics
NPI:1306844220
Name:SIMOVIC, DRASKO (MD)
Entity Type:Individual
Prefix:
First Name:DRASKO
Middle Name:
Last Name:SIMOVIC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:25 MARSTON STREET
Mailing Address - Street 2:SUITE 208
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01841
Mailing Address - Country:US
Mailing Address - Phone:978-687-2586
Mailing Address - Fax:978-687-8268
Practice Address - Street 1:25 MARSTON ST
Practice Address - Street 2:SUITE 208
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-2310
Practice Address - Country:US
Practice Address - Phone:978-687-2587
Practice Address - Fax:978-687-8268
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA795862084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3171388Medicaid
MA0011371OtherNEIGHBORHOOD HEALTH PLAN
MAA23049Medicare ID - Type Unspecified
G57836Medicare UPIN