Provider Demographics
NPI:1649281627
Name:GAFFORD, GRADY D (MD)
Entity type:Individual
Prefix:DR
First Name:GRADY
Middle Name:D
Last Name:GAFFORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:15 MEADE ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WELLSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16901-1813
Mailing Address - Country:US
Mailing Address - Phone:570-724-2131
Mailing Address - Fax:570-724-5471
Practice Address - Street 1:15 MEADE ST
Practice Address - Street 2:SUITE 1
Practice Address - City:WELLSBORO
Practice Address - State:PA
Practice Address - Zip Code:16901-1813
Practice Address - Country:US
Practice Address - Phone:570-724-2131
Practice Address - Fax:570-724-5471
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD025213E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1015038670001Medicaid
PA1015038670001Medicaid
PA0281670001Medicare NSC
PA410452Medicare PIN