Provider Demographics
NPI:1295765030
Name:GRAECA, STEVEN W, (DO)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:W,
Last Name:GRAECA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 447
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-0447
Mailing Address - Country:US
Mailing Address - Phone:814-371-1717
Mailing Address - Fax:814-375-4422
Practice Address - Street 1:145 HOSPITAL AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-1462
Practice Address - Country:US
Practice Address - Phone:814-371-1717
Practice Address - Fax:814-375-4422
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-009921-L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA025341OtherMEDICARE CMS
PA001798840Medicaid
PA001798840Medicaid