Provider Demographics
NPI:1861489890
Name:DRAKE III, WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:DRAKE III
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 SUMMIT RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MOUNTAINSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07092-2316
Mailing Address - Country:US
Mailing Address - Phone:908-233-2111
Mailing Address - Fax:908-458-9944
Practice Address - Street 1:213 SUMMIT RD
Practice Address - Street 2:SUITE 1
Practice Address - City:MOUNTAINSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07092-2316
Practice Address - Country:US
Practice Address - Phone:908-233-2111
Practice Address - Fax:908-458-9944
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA060639207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ040010257Medicare ID - Type Unspecified
NJF81286Medicare UPIN