Provider Demographics
NPI:1942355441
Name:DRAPER, AMANDA MONTGOMERY (MD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:MONTGOMERY
Last Name:DRAPER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:77 NEALY AVE
Mailing Address - Street 2:1ST MEDICAL GROUP
Mailing Address - City:LANGLEY AFB
Mailing Address - State:VA
Mailing Address - Zip Code:23665-2040
Mailing Address - Country:US
Mailing Address - Phone:757-764-9954
Mailing Address - Fax:757-764-1068
Practice Address - Street 1:77 NEALY AVE
Practice Address - Street 2:1ST MEDICAL GROUP
Practice Address - City:LANGLEY AFB
Practice Address - State:VA
Practice Address - Zip Code:23665-2040
Practice Address - Country:US
Practice Address - Phone:757-764-9954
Practice Address - Fax:757-764-1068
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA025447208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics