Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MD430668 | PA |
Y | 208600000X | Surgeon | MD430668 | PA |
N | 2086S0122X | Plastic and Reconstructive Surgery | D63524 | MD |
NPI | 1295788503 |
---|---|
Provider Name | Nirutisai K Graff |
First Address | Ephrata, PA 17522-9550 |
Second Address | Ephrata, PA 17522-1761 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 27/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1019750900001 | (05) | PA |
111124UFW | MEDICARE (01) | PA |
408404700 | (05) | MD |
H70434 | (02) | MD |