Healthcare Provider Details

I. General information

NPI: 1538427406
Provider Name (Legal Business Name): ASHLEY BROOKE GRAUL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2012
Last Update Date: 07/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 OSTRUM ST STE 502
FOUNTAIN HILL PA
18015-1153
US

IV. Provider business mailing address

701 OSTRUM ST STE 502
FOUNTAIN HILL PA
18015-1153
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-7555
  • Fax: 484-503-7001
Mailing address:
  • Phone: 484-526-7555
  • Fax: 484-503-4501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT201379
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMT201379
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberMD457669
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: