Provider Demographics
NPI:1962472258
Name:GRAVES, LYNDA CS (MD)
Entity Type:Individual
Prefix:DR
First Name:LYNDA
Middle Name:CS
Last Name:GRAVES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 SUNBURY ST
Mailing Address - Street 2:
Mailing Address - City:MINERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17954-1346
Mailing Address - Country:US
Mailing Address - Phone:570-544-9123
Mailing Address - Fax:570-544-9263
Practice Address - Street 1:210 SUNBURY ST
Practice Address - Street 2:
Practice Address - City:MINERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17954-1346
Practice Address - Country:US
Practice Address - Phone:570-544-9123
Practice Address - Fax:570-544-9263
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022224E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000731220Medicaid
PAC30605Medicare UPIN
PA000731220Medicaid