Tim Gravgaard
Individual provider Active NPI Driver · Elizabeth City, NC
NPI 1891472650 · NPPES record last updated Jul 3, 2023
Key facts
- NPI
- 1891472650
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Driver 172A00000X
- License
- 20899329 (NC)
- Practice address
- 117 Matthews Dr
Elizabeth City, NC 27909-7739 - Phone
- (757) 618-9866
- NPI assigned
- Jul 3, 2023
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20899329 | NC | MD | Driver |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | 20899329 | NC | Yes |
Addresses
Primary practice location
117 Matthews Dr
Elizabeth City, NC 27909-7739
Mailing address
117 Matthews Dr
Elizabeth City, NC 27909-7739
Phone (757) 618-9866
Other providers in Elizabeth City, NC
- Sowmya Gouru
- Scott Edward Grabill
- Graca Inc
- Marianne Gradeless
- Robert Grant
- Wyconda Denise Gray
- Taylor Balir Green
- Chelsea Elizabeth Greene
- Kinisha Greene
- Sharon Lizbeth Greene
All providers in Elizabeth City, NC · Driver in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 3, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.