Provider Demographics
NPI:1518940170
Name:DRAELOS, ZOE DIANA (MD)
Entity Type:Individual
Prefix:DR
First Name:ZOE
Middle Name:DIANA
Last Name:DRAELOS
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 1:2444 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7833
Mailing Address - Country:US
Mailing Address - Phone:336-841-2040
Mailing Address - Fax:336-841-2044
Practice Address - Street 1:2444 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-7833
Practice Address - Country:US
Practice Address - Phone:336-841-2040
Practice Address - Fax:336-841-2044
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-28
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31273207N00000X, 207ND0900X, 207NS0135X, 207NP0225X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1081XOtherBLUE CROSS AND BLUE SHIEL
NC8929147Medicaid
NC1081XOtherBLUE CROSS AND BLUE SHIEL
NC206008BMedicare ID - Type UnspecifiedPROVIDER NUMBER