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General NPI Number Information
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NPI Number | 1932160934
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Entity Type | Individual
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Provider Name | AGNES A GRAVES M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/29/2006
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Last Update Date | 02/16/2012
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Provider Practice Location Address
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Address Line | 119 WINDSOR ST
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City | CAMBRIDGE
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State | MA
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Zip | 02139-3647
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Country | US
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Telephone | 617-665-3600
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Fax | 617-665-3603
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Provider Business Mailing Address
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Address Line | 119 WINDSOR ST
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City | CAMBRIDGE
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State | MA
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Zip | 02139-3647
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Country | US
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Telephone | 617-665-3600
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Fax | 617-665-3603
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 227283
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License Number State | MA
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