Provider Demographics
NPI:1295862936
Name:GRABER, KATHERINE M (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:M
Last Name:GRABER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:LAZAROVICI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:435 FOLLY RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-2624
Mailing Address - Country:US
Mailing Address - Phone:843-795-3056
Mailing Address - Fax:843-762-2488
Practice Address - Street 1:435 FOLLY RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-2624
Practice Address - Country:US
Practice Address - Phone:843-795-3056
Practice Address - Fax:843-762-2488
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY179874207Q00000X
SC31462207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC31462OtherSC MEDICAL LICENCE
SC314626Medicaid
NY01549691Medicaid
SC314626Medicaid
NY01549691Medicaid