Provider Demographics
NPI:1487654059
Name:GRAZIANI, HUGO G (MD)
Entity Type:Individual
Prefix:
First Name:HUGO
Middle Name:G
Last Name:GRAZIANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 PERSHING DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4321
Mailing Address - Country:US
Mailing Address - Phone:301-589-5362
Mailing Address - Fax:301-608-2253
Practice Address - Street 1:717 PERSHING DRIVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4321
Practice Address - Country:US
Practice Address - Phone:301-589-5362
Practice Address - Fax:301-608-2253
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2008-08-07
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
MDD0008188207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD374291100Medicaid
MD374291100Medicaid
MD081464Medicare PIN