Provider Demographics
NPI:1235264516
Name:GRAAE, WENDY RAPPORT (MD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:RAPPORT
Last Name:GRAAE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3 TRUESDALE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH SALEM
Mailing Address - State:NY
Mailing Address - Zip Code:10590-1317
Mailing Address - Country:US
Mailing Address - Phone:914-763-0692
Mailing Address - Fax:
Practice Address - Street 1:620 EAST BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543
Practice Address - Country:US
Practice Address - Phone:914-777-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY170824-1207PP0204X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY170824-1OtherMEDICAL LICENSE