Healthcare Provider Details

I. General information

NPI: 1104906254
Provider Name (Legal Business Name): SARENA G GRACZYK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 09/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 STONERIDGE DR SUITE 304
COLUMBIA SC
29210-8013
US

IV. Provider business mailing address

PO BOX 3387
FREDERICK MD
21705-3387
US

V. Phone/Fax

Practice location:
  • Phone: 803-708-8126
  • Fax: 803-708-1370
Mailing address:
  • Phone: 888-276-1910
  • Fax: 803-708-1370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number15395
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number15395
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number15395
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: