Provider Demographics
NPI:1447241468
Name:GRAYBEAL, LAURA JANE (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:JANE
Last Name:GRAYBEAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:KEATING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:921 W NEVILLE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-4360
Mailing Address - Country:US
Mailing Address - Phone:304-254-8346
Mailing Address - Fax:304-254-8348
Practice Address - Street 1:921 W NEVILLE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-4360
Practice Address - Country:US
Practice Address - Phone:304-254-8346
Practice Address - Fax:304-254-8348
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20972207R00000X, 202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2003833000Medicaid
WVKE4091952Medicare ID - Type Unspecified
WV2003833000Medicaid
WVH33237Medicare UPIN