Provider Demographics
NPI:1720723240
Name:DRAELOS, MATTHEW MICHAEL (MD, PHD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:MICHAEL
Last Name:DRAELOS
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 SOUTH COLUMBIA ST 126 MACNIDER HALL CB#7005
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-2286
Mailing Address - Country:US
Mailing Address - Phone:919-974-4462
Mailing Address - Fax:919-843-2356
Practice Address - Street 1:40 DUKE MEDICINE CIR # 3K
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-2286
Practice Address - Country:US
Practice Address - Phone:919-684-3432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-29
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC310207390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program