MEDICARE: DR. DMITRY ALEKS DRAPACH DO

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	207Q00000X	Family Medicine Physician	0102203390	VA
2	207Q00000X	Family Medicine Physician	OS18875	FL
3	207QA0505X	Adult Medicine Physician	OS18875	FL
4	207Q00000X	Family Medicine Physician	044942	CT

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669487542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DMITRY ALEKS DRAPACH DO

Provider Business Mailing Address
First Line	:	1268 MAIN ST STE A
Second Line	:
City	:	NEWINGTON
State	:	CT
Zip	:	06111-3038
Country	:	US
Telephone Number	:	860-817-3046
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 STERTHAUS DR
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-5133
Country	:	US
Telephone Number	:	904-442-1414
Fax Number	:	386-231-5962

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

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	04/30/2024

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