Healthcare Provider Details

I. General information

NPI: 1295788503
Provider Name (Legal Business Name): NIRUTISAI K GRAFF MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 05/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 MARTIN AVE SUITE 320
EPHRATA PA
17522-1761
US

IV. Provider business mailing address

4131 OREGON PIKE SUITE C
EPHRATA PA
17522-9550
US

V. Phone/Fax

Practice location:
  • Phone: 717-721-5800
  • Fax: 717-721-5858
Mailing address:
  • Phone: 717-859-5161
  • Fax: 717-859-5169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD430668
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberD63524
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: