Healthcare Provider Details

I. General information

NPI: 1780868950
Provider Name (Legal Business Name): LAURA M GRAVELIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/24/2007
Last Update Date: 04/11/2022
Certification Date: 04/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 N MEADOWS DR
GROVE CITY OH
43123-2546
US

IV. Provider business mailing address

200 BANNING ST SUITE 340
DOVER DE
19904-3485
US

V. Phone/Fax

Practice location:
  • Phone: 614-627-2000
  • Fax:
Mailing address:
  • Phone: 302-734-1414
  • Fax: 302-734-2121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberC1-0010291
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: