Provider Demographics
NPI:1831230937
Name:DRAKE, PAMELA D (MD)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:D
Last Name:DRAKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2033 WOOD ST STE 220
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-7927
Mailing Address - Country:US
Mailing Address - Phone:941-677-3366
Mailing Address - Fax:941-677-3367
Practice Address - Street 1:2033 WOOD ST STE 220
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-7927
Practice Address - Country:US
Practice Address - Phone:941-677-3366
Practice Address - Fax:941-677-3367
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350661872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHD77688Medicare UPIN
OHDR0774051Medicare PIN
OH0213585Medicaid