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General NPI Number Information
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NPI Number | 1104906254
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Entity Type | Individual
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Provider Name | SARENA G GRACZYK MD
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Gender | Female
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 09/03/2013
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Provider Practice Location Address
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Address Line | 240 STONERIDGE DR SUITE 304
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City | COLUMBIA
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State | SC
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Zip | 29210-8013
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Country | US
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Telephone | 803-708-8126
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Fax | 803-708-1370
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Provider Business Mailing Address
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Address Line | PO BOX 3387
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City | FREDERICK
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State | MD
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Zip | 21705-3387
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Country | US
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Telephone | 888-276-1910
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Fax | 803-708-1370
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 15395
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207LC0200X
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Taxonomy Name | Critical Care Medicine (Anesthesiology) Physician
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License Number | 15395
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 15395
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License Number State | SC
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