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General NPI Number Information
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NPI Number | 1265643357
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Entity Type | Organization
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Legal Business Name | GRAVES DERMA CARE CENTER PC
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 04/30/2013
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Provider Practice Location Address
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Address Line | 1020 KINGS HWY N SUITE 101
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City | CHERRY HILL
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State | NJ
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Zip | 08034-1906
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Country | US
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Telephone | 856-321-0001
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Fax |
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Provider Business Mailing Address
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Address Line | 3900 FORD RD SUITE C
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City | PHILADELPHIA
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State | PA
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Zip | 19131-2039
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Country | US
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Telephone | 215-879-2389
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Fax | 215-879-2575
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Authorized Official
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Title or Position | PRESIDENT
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Name | VAUGHAN C GRAVES
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Credential | M.D.
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Telephone | 215-879-2389
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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