Healthcare Provider Details

I. General information

NPI: 1750354700
Provider Name (Legal Business Name): MILTON DRAKE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 11/16/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 BILLERICA RD INTERNAL MEDICINE
CHELMSFORD MA
01824-3604
US

IV. Provider business mailing address

147 MILK ST PROVIDER ENROLLMENT - 9TH FLOOR
BOSTON MA
02109-4806
US

V. Phone/Fax

Practice location:
  • Phone: 978-250-6100
  • Fax: 978-250-6470
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number39463
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: