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General NPI Number Information
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NPI Number | 1780387084
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Entity Type | Individual
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Provider Name | MARCIA GRACA PA
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Gender | Female
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Dates
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Enumeration Date | 03/24/2023
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Last Update Date | 03/24/2023
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Provider Practice Location Address
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Address Line | 5 PERRYRIDGE RD
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City | GREENWICH
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State | CT
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Zip | 06830-4608
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Country | US
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Telephone | 203-863-3840
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Fax | 203-864-4738
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Provider Business Mailing Address
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Address Line | 543 MAIN ST APT 513
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City | NEW ROCHELLE
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State | NY
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Zip | 10801-7266
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Country | US
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Telephone | 914-500-7025
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 6038
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License Number State | CT
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