Provider Demographics
NPI:1639488356
Name:MELVYN G DREW MD PA
Entity Type:Organization
Organization Name:MELVYN G DREW MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DREW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-848-2233
Mailing Address - Street 1:6610 EMBASSY BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-4897
Mailing Address - Country:US
Mailing Address - Phone:727-848-2233
Mailing Address - Fax:727-847-4945
Practice Address - Street 1:6610 EMBASSY BLVD STE C
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-4897
Practice Address - Country:US
Practice Address - Phone:727-848-2233
Practice Address - Fax:727-847-4945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0027967207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD85905Medicare UPIN
FL51090Medicare PIN