Provider Demographics
NPI:1689642670
Name:GRAFTON, MARK EDWARD (NAVY IDC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:EDWARD
Last Name:GRAFTON
Suffix:
Gender:M
Credentials:NAVY IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SAN DIEGO LOOP BLDG 3282
Mailing Address - Street 2:NAVAL AIR FACILITY BRANCH HEALTH AND DENTAL CLINICS
Mailing Address - City:ANDREWS AFB
Mailing Address - State:MD
Mailing Address - Zip Code:20762-5518
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 SAN DIEGO LOOP BLDG 3282
Practice Address - Street 2:NAVAL AIR FACILITY BRANCH HEALTH AND DENTAL C
Practice Address - City:ANDREWS AFB
Practice Address - State:MD
Practice Address - Zip Code:20762-5518
Practice Address - Country:US
Practice Address - Phone:240-857-2850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman