=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750332300
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ESTELLA F. GRAEFFE MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2006
-----------------------------------------------------
Last Update Date | 06/01/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 211 S GULPH RD STE 200
-----------------------------------------------------
City | KING OF PRUSSIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19406-3101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-382-5900
-----------------------------------------------------
Fax | 610-382-5919
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 211 S GULPH RD SUITE 200
-----------------------------------------------------
City | KING OF PRUSSIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19406-3101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-382-5900
-----------------------------------------------------
Fax | 610-382-5919
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | MD023032E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2085R0203X
-----------------------------------------------------
Taxonomy Name | Therapeutic Radiology Physician
-----------------------------------------------------
License Number | MD023032E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2085R0001X
-----------------------------------------------------
Taxonomy Name | Radiation Oncology Physician
-----------------------------------------------------
License Number | MD023032E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------