Provider Demographics
NPI:1306061551
Name:GRAEF, BENJAMIN P (DO)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:P
Last Name:GRAEF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 LE PHILLIP CT NE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2984
Mailing Address - Country:US
Mailing Address - Phone:704-248-0000
Mailing Address - Fax:877-335-8171
Practice Address - Street 1:212 LE PHILLIP CT NE
Practice Address - Street 2:SUITE 105
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2984
Practice Address - Country:US
Practice Address - Phone:704-248-0000
Practice Address - Fax:877-335-8171
Is Sole Proprietor?:No
Enumeration Date:2007-04-14
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008947207RS0012X
NC185517207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNC2099Medicaid
NC187AXOtherBCBS
NCNCI407AOtherMEDICARE - NC
OH2784161Medicaid
NC7693936OtherAETNA
SC30184003OtherSELECT HEALTH
NC4578714OtherCIGNA
OH4215541Medicare PIN