Healthcare Provider Details

I. General information

NPI: 1134217862
Provider Name (Legal Business Name): KENNETH C. GRAFFEO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 W CENTRAL AVE STE 103
DELAWARE OH
43015-1498
US

IV. Provider business mailing address

PO BOX 7527
DUBLIN OH
43017-0727
US

V. Phone/Fax

Practice location:
  • Phone: 740-363-1473
  • Fax: 740-369-5718
Mailing address:
  • Phone: 740-615-1324
  • Fax: 740-615-1344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number35.084804
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35.084804
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: