Healthcare Provider Details

I. General information

NPI: 1538506779
Provider Name (Legal Business Name): LAUREN ELIZABETH DRAKE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2013
Last Update Date: 05/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9101 FRANKLIN SQUARE DR STE 300
BALTIMORE MD
21237
US

IV. Provider business mailing address

9101 FRANKLIN SQUARE DR STE 300
BALTIMORE MD
21237-3966
US

V. Phone/Fax

Practice location:
  • Phone: 443-777-2000
  • Fax: 866-857-9388
Mailing address:
  • Phone: 443-777-2000
  • Fax: 866-857-9388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0080955
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: