Provider Demographics
NPI:1669487542
Name:DRAPACH, DMITRY ALEKS (DO)
Entity Type:Individual
Prefix:DR
First Name:DMITRY
Middle Name:ALEKS
Last Name:DRAPACH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1268 MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-3038
Mailing Address - Country:US
Mailing Address - Phone:860-817-3046
Mailing Address - Fax:
Practice Address - Street 1:901 STERTHAUS DR
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5133
Practice Address - Country:US
Practice Address - Phone:904-442-1414
Practice Address - Fax:386-231-5962
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102203390207Q00000X
FLOS18875207QA0505X
CT044942207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1669487542Medicaid
VA1669487542Medicaid
VAVV9959AMedicare PIN