Provider Demographics
NPI:1902914740
Name:DRAKE, GREGORY (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:DRAKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2421 SILVER STREAM LN
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7684
Mailing Address - Country:US
Mailing Address - Phone:910-341-3389
Mailing Address - Fax:910-815-3144
Practice Address - Street 1:2421 SILVER STREAM LANE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401
Practice Address - Country:US
Practice Address - Phone:910-341-3389
Practice Address - Fax:910-815-3144
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23841208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC126CNOtherBCBS NC
NC89126CNMedicaid
NC340018123OtherRAILROAD MEDICARE
NC2280290Medicare PIN
NCH13608Medicare UPIN