Provider Demographics
NPI:1750354700
Name:DRAKE, MILTON (MD)
Entity type:Individual
Prefix:
First Name:MILTON
Middle Name:
Last Name:DRAKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:147 MILK ST
Mailing Address - Street 2:PROVIDER ENROLLMENT - 9TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4806
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:228 BILLERICA RD
Practice Address - Street 2:INTERNAL MEDICINE
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-3604
Practice Address - Country:US
Practice Address - Phone:978-250-6100
Practice Address - Fax:978-250-6470
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA39463207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA039463OtherTUFTS
MA3192504Medicaid
MAJ09913OtherBLUE CROSS
MAPV275OtherHARVARD PILGRIM
MA039463OtherTUFTS
MAD87218Medicare UPIN