Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 238601 | MA |
NPI | 1154415875 |
---|---|
Provider Name | Dr. Geoffrey M Graeber |
First Address | Boston, MA 02241-5348 |
Second Address | Worcester, MA 01605-2657 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 03/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0128931000 | (05) | WV |
040004483 | RAILROAD MEDICARE (01) | WV |
E29107 | (02) |