Healthcare Provider Details

I. General information

NPI: 1235398355
Provider Name (Legal Business Name): GRAHAM G LAURENCE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2008
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PINE GROVE CMNS
YORK PA
17403-5176
US

IV. Provider business mailing address

429 N 21ST ST
CAMP HILL PA
17011-2202
US

V. Phone/Fax

Practice location:
  • Phone: 717-851-6110
  • Fax: 717-741-1076
Mailing address:
  • Phone: 717-761-7244
  • Fax: 717-761-2055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD456389
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberMD456389
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberMD456389
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: