Provider Demographics
NPI:1639192941
Name:GRAZIANI, CORINA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:CORINA
Middle Name:MARIE
Last Name:GRAZIANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CORINA
Other - Middle Name:M
Other - Last Name:NAHMIAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2100 SPRING GARDEN STREET
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-3502
Mailing Address - Country:US
Mailing Address - Phone:215-955-9555
Mailing Address - Fax:215-988-0545
Practice Address - Street 1:2100 SPRING GARDEN STREET
Practice Address - Street 2:3RD FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-3502
Practice Address - Country:US
Practice Address - Phone:215-988-9555
Practice Address - Fax:215-988-0545
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD054599L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015131720003Medicaid
PA635056Medicare PIN