Provider Demographics
NPI:1780752634
Name:SUCHESKI-DRAKE, AMY E (MD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:E
Last Name:SUCHESKI-DRAKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:E
Other - Last Name:SUCHESKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:110 HO PLZ
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14853-3102
Mailing Address - Country:US
Mailing Address - Phone:607-255-5155
Mailing Address - Fax:
Practice Address - Street 1:110 HO PLZ
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14853-3102
Practice Address - Country:US
Practice Address - Phone:607-255-5155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY267020-1207QS0010X
MEMD18314207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30209644Medicaid
MEP01010602Medicare PIN
ME001750702Medicare PIN
MEP00928352Medicare PIN
ME001750701Medicare PIN