Healthcare Provider Details

I. General information

NPI: 1073680856
Provider Name (Legal Business Name): VINCENT ANTHONY GRAFFEO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 10/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 MEDICAL CENTER DR SUITE B510
HUNTINGTON WV
25701-3656
US

IV. Provider business mailing address

1600 MEDICAL CENTER DR SUITE B510
HUNTINGTON WV
25701-3656
US

V. Phone/Fax

Practice location:
  • Phone: 304-691-8850
  • Fax: 304-523-9470
Mailing address:
  • Phone: 304-691-8850
  • Fax: 304-523-9470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number46252-020
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number23781
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: