MEDICARE: GRAVES MEDICAL PRACTICE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	1301	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437271707
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRAVES MEDICAL PRACTICE INC

Provider Business Mailing Address
First Line	:	PO BOX 598
Second Line	:
City	:	BERKELEY SPRINGS
State	:	WV
Zip	:	25411-0598
Country	:	US
Telephone Number	:	304-258-6327
Fax Number	:	304-258-6332

Provider Business Practice Location Address
First Line	:	261 BERKMORE PL
Second Line	:	SUITE 1A
City	:	BERKELEY SPRINGS
State	:	WV
Zip	:	25411-6247
Country	:	US
Telephone Number	:	304-258-6327
Fax Number	:	304-258-6332

Authorized Official
Title or Position	:	OWNER
Name	:	DR. WILLIAM RICK GRAVES
Credential	:	D.O.
Telephone Number	:	304-258-6327

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	08/22/2020

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