Provider Demographics
NPI:1104864172
Name:GRAVES, JEFFREY M (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:M
Last Name:GRAVES
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 1:7001 FOREST AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-1726
Mailing Address - Country:US
Mailing Address - Phone:804-237-8282
Mailing Address - Fax:804-672-4948
Practice Address - Street 1:7001 FOREST AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-1726
Practice Address - Country:US
Practice Address - Phone:804-237-8282
Practice Address - Fax:804-672-4948
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20427207R00000X
VA0101034376207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00013537OtherRAILROAD MEDICARE
WVP00013537OtherRAILROAD PTAN
WV000894844OtherBLUE CROSS BLUE SHIELD
WV000894844OtherBLUE CROSS BLUE SHIELD
WV4052681Medicare PIN