Provider Demographics
NPI:1982680575
Name:GRAEF, JOHN W (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:GRAEF
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:147 MILK STREET
Mailing Address - Street 2:PROVIDER ENROLLMENT - 9TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4862
Mailing Address - Country:US
Mailing Address - Phone:617-559-8053
Mailing Address - Fax:617-421-3487
Practice Address - Street 1:333 LONGWOOD AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5711
Practice Address - Country:US
Practice Address - Phone:617-355-8263
Practice Address - Fax:617-277-8934
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA33948208000000X, 2080T0002X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered2080T0002XAllopathic & Osteopathic PhysiciansPediatricsMedical Toxicology
Not Answered208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAV02406OtherBLUE CROSS
MAPP624OtherHARVARD PILGRIM
MA0003908OtherNEIGHBORHOOD HEALTH
MA2020785Medicaid
MA4147717-003OtherCIGNA
MA715698OtherTUFTS
MA0003908OtherNEIGHBORHOOD HEALTH
MAV02406OtherBLUE CROSS