Provider Demographics
NPI:1063960920
Name:DRUYOR, JOHN A (FNP-C)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:DRUYOR
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 S. ATWOOD ROAD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014
Mailing Address - Country:US
Mailing Address - Phone:410-838-9555
Mailing Address - Fax:410-836-5056
Practice Address - Street 1:615 W MACPHAIL RD
Practice Address - Street 2:SUITE 107
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014
Practice Address - Country:US
Practice Address - Phone:410-838-9555
Practice Address - Fax:410-836-5056
Is Sole Proprietor?:No
Enumeration Date:2016-09-20
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR154281363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD113850200Medicaid