Provider Demographics
NPI:1003838251
Name:GRAZIANO, DINO A (MD)
Entity Type:Individual
Prefix:
First Name:DINO
Middle Name:A
Last Name:GRAZIANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3104 LOVE CT
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28056-8869
Mailing Address - Country:US
Mailing Address - Phone:704-864-5828
Mailing Address - Fax:
Practice Address - Street 1:3104 LOVE CT
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28056-8869
Practice Address - Country:US
Practice Address - Phone:704-813-9463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34615207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8936843Medicaid
NC8936843Medicaid
NC2165938D NCMedicare PIN
NC2165938KMedicare PIN
SCAA36147772Medicare PIN