MEDICARE: DR. RANDALL DRAKE EHRBAR PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PSY 1000756	DC
2	103T00000X	Psychologist	05164	MD

General Provider Information

NPI Number	:	1043248644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDALL DRAKE EHRBAR PSYD

Provider Business Mailing Address
First Line	:	4400 EAST WEST HWY
Second Line	:	SUITE 1028
City	:	BETHESDA
State	:	MD
Zip	:	20814-4524
Country	:	US
Telephone Number	:	301-204-1411
Fax Number	:	301-907-3241

Provider Business Practice Location Address
First Line	:	4400 EAST WEST HWY
Second Line	:	SUITE 1028
City	:	BETHESDA
State	:	MD
Zip	:	20814-4524
Country	:	US
Telephone Number	:	301-204-1411
Fax Number	:	301-907-3241

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	10/15/2012

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