Provider Demographics
NPI:1235398355
Name:LAURENCE, GRAHAM G (MD)
Entity Type:Individual
Prefix:DR
First Name:GRAHAM
Middle Name:G
Last Name:LAURENCE
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 1:429 N 21ST ST
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-2202
Mailing Address - Country:US
Mailing Address - Phone:717-761-7244
Mailing Address - Fax:717-761-2055
Practice Address - Street 1:300 PINE GROVE CMNS
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-5176
Practice Address - Country:US
Practice Address - Phone:717-851-6110
Practice Address - Fax:717-741-1076
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD456389208600000X, 2086S0127X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103130736Medicaid
PAPO1831813OtherRAILROAD MEDICARE
PA103130736Medicaid