Provider Demographics
NPI:1245314103
Name:GRABIAS, STANLEY L JR (MD)
Entity type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:L
Last Name:GRABIAS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2201 RIDGEWOOD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1189
Mailing Address - Country:US
Mailing Address - Phone:610-375-6226
Mailing Address - Fax:610-375-6200
Practice Address - Street 1:2201 RIDGEWOOD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1189
Practice Address - Country:US
Practice Address - Phone:610-375-6226
Practice Address - Fax:610-375-6200
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD12376E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0730278Medicaid
PA134157Medicare ID - Type Unspecified