Provider Demographics
NPI:1649271602
Name:DRAKE, CODY M (DPM)
Entity type:Individual
Prefix:DR
First Name:CODY
Middle Name:M
Last Name:DRAKE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CLEVELAND AVE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-2937
Mailing Address - Country:US
Mailing Address - Phone:276-632-5280
Mailing Address - Fax:276-632-5257
Practice Address - Street 1:15 CLEVELAND AVE
Practice Address - Street 2:SUITE 9
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-2937
Practice Address - Country:US
Practice Address - Phone:276-632-5280
Practice Address - Fax:276-632-5257
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC304213ES0103X
VA0103000961213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890812EMedicaid
NC2432292FMedicare ID - Type Unspecified
NCU02680Medicare UPIN