Provider Demographics
NPI:1336149996
Name:GRAVELY, CHANDRA YVETTE (MD)
Entity Type:Individual
Prefix:MRS
First Name:CHANDRA
Middle Name:YVETTE
Last Name:GRAVELY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4422 CARVER WOODS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-5599
Mailing Address - Country:US
Mailing Address - Phone:513-891-0211
Mailing Address - Fax:513-792-5945
Practice Address - Street 1:10700 MONTGOMERY RD
Practice Address - Street 2:SUITE 311
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242
Practice Address - Country:US
Practice Address - Phone:513-891-0211
Practice Address - Fax:513-792-5945
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35.062556207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0936438Medicaid
F63384Medicare UPIN