Provider Demographics
NPI:1689655300
Name:DRURY, MICHAEL C (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:DRURY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:GU MULTI-SPECIALTY CLINIC, NORTH PAVILION, 4TH FLOOR
Mailing Address - Street 2:SMILO CANCER HOSPITAL AT YALE-NEW HAVEN
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510
Mailing Address - Country:US
Mailing Address - Phone:203-737-7911
Mailing Address - Fax:
Practice Address - Street 1:GU MULTI-SPECIALTY CLINIC, NORTH PAVILION, 4TH FLOOR
Practice Address - Street 2:SMILO CANCER HOSPITAL AT YALE-NEW HAVEN
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510
Practice Address - Country:US
Practice Address - Phone:203-737-7911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001000363AM0700X
CAPA19752363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q33246Medicare UPIN
CTD400003186Medicare PIN