MEDICARE: DRASKO SIMOVIC MD

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	2084N0400X	Neurology Physician	79586	MA
2	2084N0600X	Clinical Neurophysiology Physician	79586	MA

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
2	0011371	OTHER	MA	NEIGHBORHOOD HEALTH PLAN

General Provider Information

NPI Number	:	1306844220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DRASKO SIMOVIC MD

Provider Business Mailing Address
First Line	:	25 MARSTON STREET
Second Line	:	SUITE 208
City	:	LAWRENCE
State	:	MA
Zip	:	01841
Country	:	US
Telephone Number	:	978-687-2586
Fax Number	:	978-687-8268

Provider Business Practice Location Address
First Line	:	25 MARSTON ST
Second Line	:	SUITE 208
City	:	LAWRENCE
State	:	MA
Zip	:	01841-2310
Country	:	US
Telephone Number	:	978-687-2587
Fax Number	:	978-687-8268

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	06/24/2019

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Directions to “ DRASKO SIMOVIC MD” Practice Location

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