Provider Demographics
NPI:1528066610
Name:GRAVES, LINDA M (MD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:M
Last Name:GRAVES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07514-1425
Mailing Address - Country:US
Mailing Address - Phone:973-523-8718
Mailing Address - Fax:973-278-0709
Practice Address - Street 1:705 BROADWAY
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07514-1425
Practice Address - Country:US
Practice Address - Phone:973-523-8718
Practice Address - Fax:973-278-0709
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ208100000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG57114Medicare UPIN
NJ901613TLQMedicare ID - Type Unspecified