MEDICARE: MRS. SUSAN P. DRAGO RPA-C, MPAS

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	363A00000X	Physician Assistant	006123	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750335089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN P. DRAGO RPA-C, MPAS

Provider Business Mailing Address
First Line	:	4526 WHITETAIL CT
Second Line	:
City	:	HAMBURG
State	:	NY
Zip	:	14075-5449
Country	:	US
Telephone Number	:	716-649-6380
Fax Number	:	716-649-6380

Provider Business Practice Location Address
First Line	:	4535 SOUTHWESTERN BLVD
Second Line	:	SEDONA HOLISTIC MEDICAL CENTRE
City	:	HAMBURG
State	:	NY
Zip	:	14075-1860
Country	:	US
Telephone Number	:	716-646-6075
Fax Number	:	716-649-6380

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

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	11/10/2009

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