Provider Demographics
NPI:1265424931
Name:GRAPER, RICHARD D (PA C)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:D
Last Name:GRAPER
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2790 MOSSIDE BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-2743
Mailing Address - Country:US
Mailing Address - Phone:412-372-2277
Mailing Address - Fax:412-373-2307
Practice Address - Street 1:2790 MOSSIDE BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2743
Practice Address - Country:US
Practice Address - Phone:412-372-2277
Practice Address - Fax:412-373-2307
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA000052L363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Not Answered363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R06033Medicare UPIN
PA087881TTSMedicare ID - Type Unspecified