Provider Demographics
NPI:1306862040
Name:GRAVES, GRETCHEN DENISE (MD)
Entity Type:Individual
Prefix:DR
First Name:GRETCHEN
Middle Name:DENISE
Last Name:GRAVES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2260 GLADSTONE DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-5125
Mailing Address - Country:US
Mailing Address - Phone:925-427-0391
Mailing Address - Fax:925-427-6797
Practice Address - Street 1:2260 GLADSTONE DR
Practice Address - Street 2:SUITE 2
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-5125
Practice Address - Country:US
Practice Address - Phone:925-427-0391
Practice Address - Fax:925-427-6797
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG46185208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G461850Medicaid
CA00G461850Medicare PIN
CAA50317Medicare UPIN
CA00G461850Medicaid