Provider Demographics
NPI:1326255209
Name:GRAYNOVSKY, MARGARET (MD)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:GRAYNOVSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:
Other - Last Name:GRAYNOVSKAYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:20 HOMESTEAD AVE
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-6638
Mailing Address - Country:US
Mailing Address - Phone:703-599-9496
Mailing Address - Fax:
Practice Address - Street 1:20 HOMESTEAD AVE
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-6638
Practice Address - Country:US
Practice Address - Phone:703-599-9496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101226840208100000X, 2081H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081H0002XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010079039Medicaid
VAH22418Medicare UPIN
VA00565M65Medicare ID - Type UnspecifiedMEDICARE ID#
005656M65Medicare PIN
VA010079039Medicaid