Provider Demographics
NPI:1467557629
Name:GRAZIANI, VIRGINIA (MD)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:
Last Name:GRAZIANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1999 NEW RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-1060
Mailing Address - Country:US
Mailing Address - Phone:609-601-6363
Mailing Address - Fax:609-601-6364
Practice Address - Street 1:1999 NEW RD
Practice Address - Street 2:SUITE B
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1060
Practice Address - Country:US
Practice Address - Phone:609-601-6363
Practice Address - Fax:609-601-6364
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA067465208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7521006Medicaid
E52510Medicare UPIN
NJ7521006Medicaid