Provider Demographics
NPI:1104919133
Name:GRAVES, GEORGE W (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:W
Last Name:GRAVES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5530 WISCONSIN AVENUE
Mailing Address - Street 2:STE 1400
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-4404
Mailing Address - Country:US
Mailing Address - Phone:301-656-9170
Mailing Address - Fax:301-654-5893
Practice Address - Street 1:5530 WISCONSIN AVENUE
Practice Address - Street 2:STE 1400
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4404
Practice Address - Country:US
Practice Address - Phone:301-656-9170
Practice Address - Fax:301-654-5893
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0029353207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
068598N27Medicare ID - Type Unspecified
C61720Medicare UPIN