Provider Demographics
NPI:1750376950
Name:TILLEY, DRAKE HAMILTON JR (MD MPH&TM)
Entity type:Individual
Prefix:DR
First Name:DRAKE
Middle Name:HAMILTON
Last Name:TILLEY
Suffix:JR
Gender:M
Credentials:MD MPH&TM
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Mailing Address - Street 1:695 KINKAID RD
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21402-1006
Mailing Address - Country:US
Mailing Address - Phone:410-293-7920
Mailing Address - Fax:410-293-3546
Practice Address - Street 1:695 KINKAID RD
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21402-1006
Practice Address - Country:US
Practice Address - Phone:410-293-7920
Practice Address - Fax:410-293-3546
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2022-08-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101233383207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty