MEDICARE: ASHLEY A GRAVEN CPT

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	156F00000X	Technician/Technologist	N8L4C3C7

General Provider Information

NPI Number	:	1487369088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY A GRAVEN CPT

Provider Business Mailing Address
First Line	:	3688 NORTH ST # 1
Second Line	:
City	:	MADISON
State	:	NY
Zip	:	13402-9707
Country	:	US
Telephone Number	:	315-761-2434
Fax Number	:

Provider Business Practice Location Address
First Line	:	3688 NORTH ST # 1
Second Line	:
City	:	MADISON
State	:	NY
Zip	:	13402-9707
Country	:	US
Telephone Number	:	315-761-2434
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2023
Last Update Date	:	01/18/2023

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