Provider Demographics
NPI:1003013160
Name:GRABENSTEIN, WILLIAM P (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:P
Last Name:GRABENSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1822 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-4605
Mailing Address - Country:US
Mailing Address - Phone:931-552-8012
Mailing Address - Fax:931-551-3118
Practice Address - Street 1:1822 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4605
Practice Address - Country:US
Practice Address - Phone:931-552-8012
Practice Address - Fax:931-551-3118
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD017935207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3728817OtherMEDICARE PTAN
TN4102307OtherBLUE CROSS BLUE SHIELD
TN3728817Medicaid
TNA99546Medicare UPIN
TN0003031899Medicare NSC