Provider Demographics
NPI:1659363075
Name:GRAYDON, ROLAND JAMES (MD)
Entity Type:Individual
Prefix:
First Name:ROLAND
Middle Name:JAMES
Last Name:GRAYDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:85 SEYMOUR ST
Mailing Address - Street 2:SUITE 416
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-5501
Mailing Address - Country:US
Mailing Address - Phone:860-947-8500
Mailing Address - Fax:860-524-8643
Practice Address - Street 1:85 SEYMOUR ST
Practice Address - Street 2:SUITE 416
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5501
Practice Address - Country:US
Practice Address - Phone:860-947-8500
Practice Address - Fax:860-524-8643
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2011-03-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT015005208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001150051Medicaid
CT06-1406459OtherPRIVATE HEALTHCARE SYSTEM
MA3164870Medicaid
CT06-1406459OtherHMC, PPO
CT06-1406459OtherCORVEL
CT06-1406459OtherMULTIPLAN
CT06-1406459OtherCOMMUNITY HEALTH NETWORK
CT0S0306OtherHEALTH NET
CT06-1406459OtherNORTHEAST HEALTH DIRECT
CT076049OtherCONNECTICARE
CT06-1406459OtherFOCUS
CT06-1406459OtherGREAT-WEST HEALTHCARE
CT2054764OtherAETNA
CT06-1406459OtherTRICARE
CT12739OtherHEALTH NEW ENGLAND
CT342585OtherWELLCARE
CTP1096767OtherOXFORD
CT010015005CT01OtherANTHEM BCBS
CT06-1406459OtherCOLONIAL COOPERATIVE CARE
CT06-1406459OtherUNITED HEALTHCARE
CT4915512 001OtherCIGNA
CT0S0306OtherHEALTH NET
CT001150051Medicaid