Provider Demographics
NPI:1184693616
Name:DREWS, MARK ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ROBERT
Last Name:DREWS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:495 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-1007
Mailing Address - Country:US
Mailing Address - Phone:617-783-0500
Mailing Address - Fax:617-987-8222
Practice Address - Street 1:564 MAIN ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02452-5516
Practice Address - Country:US
Practice Address - Phone:781-693-3800
Practice Address - Fax:781-693-5514
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA73118207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAF01409Medicare UPIN
MAJ11695Medicare ID - Type Unspecified