Provider Demographics
NPI:1104829357
Name:DREW, PHILIP T (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:T
Last Name:DREW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 PAXWOOD ROAD
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054
Mailing Address - Country:US
Mailing Address - Phone:518-439-0509
Mailing Address - Fax:518-439-8145
Practice Address - Street 1:79 PAXWOOD ROAD
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054
Practice Address - Country:US
Practice Address - Phone:518-439-8555
Practice Address - Fax:518-439-8145
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY150805207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00722050Medicaid
NY00722050Medicaid
38849CMedicare ID - Type Unspecified