Provider Demographics
NPI:1366717837
Name:DRAKOS, MICHAEL JONATHAN (LAC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JONATHAN
Last Name:DRAKOS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5182 DOWNWEST RIDE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-1505
Mailing Address - Country:US
Mailing Address - Phone:410-707-0661
Mailing Address - Fax:
Practice Address - Street 1:601 POST OFFICE RD
Practice Address - Street 2:STE 2D
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-1912
Practice Address - Country:US
Practice Address - Phone:301-848-0461
Practice Address - Fax:301-885-0922
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-17
Last Update Date:2012-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01971171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist