Healthcare Provider Details

I. General information

NPI: 1659073294
Provider Name (Legal Business Name): CAROLYN MARIE GRACHEN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10101 RIDGEGATE PKWY
LONE TREE CO
80124-5522
US

IV. Provider business mailing address

113 SHAG BARK LN
VENETIA PA
15367-1157
US

V. Phone/Fax

Practice location:
  • Phone: 720-225-1000
  • Fax:
Mailing address:
  • Phone: 724-825-3099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDR.0075574
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: