Provider Demographics
NPI:1073673331
Name:GRAZIANO, VICTORIA MARIE
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:MARIE
Last Name:GRAZIANO
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:VICTORIA
Other - Middle Name:MARIE
Other - Last Name:GRAZIANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2214 COMMERCE PKWY
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-4301
Mailing Address - Country:US
Mailing Address - Phone:757-463-5844
Mailing Address - Fax:757-463-9349
Practice Address - Street 1:2214 COMMERCE PKWY
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-4301
Practice Address - Country:US
Practice Address - Phone:757-463-5844
Practice Address - Fax:757-463-9349
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-09
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA42373OtherOPTIMA PROVIDER NUMBER
VA463098OtherANTHEM PROVIDER NUMBER
VA278426OtherANTHEM MEDIGAP NUMBER
VA463098OtherANTHEM PROVIDER NUMBER