Provider Demographics
NPI:1821398611
Name:GRAPER COSMETIC SURGERY
Entity Type:Organization
Organization Name:GRAPER COSMETIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-375-7111
Mailing Address - Street 1:2915 COLTSGATE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-3882
Mailing Address - Country:US
Mailing Address - Phone:704-375-7111
Mailing Address - Fax:704-375-0444
Practice Address - Street 1:2915 COLTSGATE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-3882
Practice Address - Country:US
Practice Address - Phone:704-375-7111
Practice Address - Fax:704-375-0444
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROBERT G. GRAPER, M.D.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33669208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2142544CMedicare PIN
NCB87946Medicare UPIN