Healthcare Provider Details

I. General information

NPI: 1740714047
Provider Name (Legal Business Name): MELANIE RACHEL GRABER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2017
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 GRAND STREET OUTPATIENT CLINIC - THE HOSPITAL OF CENTRAL CONNECTICUT
NEW BRITAIN CT
06050
US

IV. Provider business mailing address

100 GRAND ST STE E119
NEW BRITAIN CT
06052-2016
US

V. Phone/Fax

Practice location:
  • Phone: 860-224-5261
  • Fax: 860-224-5957
Mailing address:
  • Phone: 860-224-5990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number066544
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number319002
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: