Provider Demographics
NPI:1134865850
Name:DRAGO, ALICIA NICOLE GAYLEEN (MD)
Entity type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:NICOLE GAYLEEN
Last Name:DRAGO
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 ELLICOTT ST.
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203
Mailing Address - Country:US
Mailing Address - Phone:716-323-2000
Mailing Address - Fax:
Practice Address - Street 1:818 ELLICOTT ST.
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203
Practice Address - Country:US
Practice Address - Phone:716-323-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-05
Last Update Date:2025-04-07
Deactivation Date:2022-12-13
Deactivation Code:
Reactivation Date:2023-02-17
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program