Provider Demographics
NPI:1558603944
Name:GRAUMANN, MARTIN PANCZEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:PANCZEL
Last Name:GRAUMANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MARTIN
Other - Middle Name:P
Other - Last Name:GRAUMANN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:16055 VENTURA BLVD STE 1120
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2612
Mailing Address - Country:US
Mailing Address - Phone:304-382-5076
Mailing Address - Fax:
Practice Address - Street 1:1200 J D ANDERSON DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3494
Practice Address - Country:US
Practice Address - Phone:304-382-5076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV27830207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA47960OtherCALIFORNIA MEDICAL LICENSE