Provider Demographics
NPI:1700807674
Name:DRAGOI, SERBAN A (MD)
Entity Type:Individual
Prefix:
First Name:SERBAN
Middle Name:A
Last Name:DRAGOI
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 1:3800 RESERVOIR RD NW # 6-PHC
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-2113
Mailing Address - Country:US
Mailing Address - Phone:646-942-0010
Mailing Address - Fax:
Practice Address - Street 1:3800 RESERVOIR RD NW # 6-PHC
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-2113
Practice Address - Country:US
Practice Address - Phone:646-942-0010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006016508207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200938108Medicaid
MO753685OtherHEALTHLINK
MO209947OtherBLUE SHIELD
DCP00722667OtherRAILROAD MEDICARE
MO753685OtherHEALTHLINK
MO958745236Medicare PIN
MOI58478Medicare UPIN
MO200938108Medicaid