Graves Derma Care Center, PC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

MD 028158E Issued in PA

Legal business name

GRAVES DERMA CARE CENTER, PC

Practice address

601 Walnut St
Suite L90
Philadelphia, PA 19106-3304

Phone

(215) 238-1622

Fax

(215) 238-1944

NPI assigned

Jan 2, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Vaughan Channing Graves, M.D.NPI 1386687002

Title

Ceo President

Phone

(215) 879-2389

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Vaughan C Graves, MD

  • Dermatology Physician
  • Phila, PA
  • NPI 1386687002
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211241600000",
    "number": "1891852653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 WALNUT ST",
            "address_2": "SUITE L90",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191063304",
            "telephone_number": "215-238-1622",
            "fax_number": "215-238-1944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 WALNUT ST",
            "address_2": "SUITE L90",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191063304",
            "telephone_number": "215-238-1622",
            "fax_number": "215-238-1944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAVES DERMA CARE CENTER, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-02",
        "last_updated": "2008-05-20",
        "status": "A",
        "authorized_official_last_name": "GRAVES",
        "authorized_official_first_name": "VAUGHAN",
        "authorized_official_middle_name": "CHANNING",
        "authorized_official_title_or_position": "CEO PRESIDENT",
        "authorized_official_telephone_number": "215-879-2389",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "PA",
            "license": "MD 028158E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0009410580004",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Silvia Gratz, D.O.
• Jennifer Lynn Grau, P.T., D.P.T.
• Dietrich Gravenstein, MD
• Steven Howard Graver, MD
• Kathleen Danielle Graveran, MD
• Amanda Elizabeth Graves
• Anthony Freeman Graves, FNP-C
• Dana Graves, DDS
• Derrick Brandon Graves, D.M.D.
• Holly L Graves, MD

• Dermatology Physician in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Dermatology Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.