Provider Demographics
NPI:1932286028
Name:DRABYN, GERALD A (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:A
Last Name:DRABYN
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 1:364 HOUGHTONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:VT
Mailing Address - Zip Code:05146-9653
Mailing Address - Country:US
Mailing Address - Phone:802-843-2004
Mailing Address - Fax:802-843-2006
Practice Address - Street 1:3 CAMPBELL ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-1335
Practice Address - Country:US
Practice Address - Phone:603-443-9993
Practice Address - Fax:603-443-9793
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11474174400000X
VT042-0010243174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH01Y003535NH01OtherANTHEM BCBS
VT58259OtherBLUE CROSS BLUE SHIELD
NHRE6478Medicare ID - Type Unspecified
NH01Y003535NH01OtherANTHEM BCBS
VTVN2742Medicare ID - Type Unspecified