Provider Demographics
NPI:1811191828
Name:DRAKE, BETSY A (MD)
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:A
Last Name:DRAKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BETSY
Other - Middle Name:A
Other - Last Name:BARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4421 EASTGATE BLVD
Mailing Address - Street 2:STE. 300
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45245-4500
Mailing Address - Country:US
Mailing Address - Phone:513-752-8000
Mailing Address - Fax:513-752-1078
Practice Address - Street 1:4421 EASTGATE BLVD
Practice Address - Street 2:STE. 300
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-4500
Practice Address - Country:US
Practice Address - Phone:513-752-8000
Practice Address - Fax:513-752-1078
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35093217207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2963360Medicaid
OH2963360Medicaid