=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174517395
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WILLIAM A GRABER MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1724 BURRSTONE RD
-----------------------------------------------------
City | NEW HARTFORD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13413-1002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-624-4740
-----------------------------------------------------
Fax | 315-624-4760
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2003
-----------------------------------------------------
City | EAST SYRACUSE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13057-4503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-446-3904
-----------------------------------------------------
Fax | 315-445-2936
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | WILLIAM A GRABER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 315-624-4740
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------