Provider Demographics
NPI:1598705543
Name:GRAVES, SUZANNE FARROW (MD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:FARROW
Last Name:GRAVES
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:83 HERRICK ST
Mailing Address - Street 2:GARDEN CITY PEDIATRIC ASSOC INC
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915
Mailing Address - Country:US
Mailing Address - Phone:978-927-4980
Mailing Address - Fax:978-922-9115
Practice Address - Street 1:83 HERRICK ST
Practice Address - Street 2:GARDEN CITY PEDIATRIC ASSOC INC
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915
Practice Address - Country:US
Practice Address - Phone:978-927-4980
Practice Address - Fax:978-922-9115
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA75705208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3115399Medicaid
F61534Medicare UPIN