Provider Demographics
NPI:1487601118
Name:DRAKHLIN, YEVGENIY F (MD)
Entity type:Individual
Prefix:
First Name:YEVGENIY
Middle Name:F
Last Name:DRAKHLIN
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 1:362 N BEDFORD ST
Mailing Address - Street 2:
Mailing Address - City:EAST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02333-1148
Mailing Address - Country:US
Mailing Address - Phone:508-350-2350
Mailing Address - Fax:508-350-2318
Practice Address - Street 1:152 DEAN ST
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-2766
Practice Address - Country:US
Practice Address - Phone:508-824-3872
Practice Address - Fax:508-822-7975
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA154643207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA69889OtherHPHC
MA156643OtherTUFTS
MAMX3823OtherMEDICARE PTAN #
J18866OtherBLUE CROSS & BLUE SHIELD
MA3178986Medicaid
MAG65937Medicare UPIN
MA3178986Medicaid