1750332300 NPI number — ESTELLA F. GRAEFFE MD

Table of content: DR. JORGE FORTUN MD (NPI 1184736464)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750332300 NPI number — ESTELLA F. GRAEFFE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRAEFFE
Provider First Name:
ESTELLA
Provider Middle Name:
F.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750332300
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/01/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
211 S GULPH RD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
KING OF PRUSSIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19406-3101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-382-5900
Provider Business Mailing Address Fax Number:
610-382-5919

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
211 S GULPH RD STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KING OF PRUSSIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19406-3101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-382-5900
Provider Business Practice Location Address Fax Number:
610-382-5919
Provider Enumeration Date:
05/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  MD023032E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0203X , with the licence number: MD023032E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0001X , with the licence number: MD023032E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0098332501 . This is a "AMERICHOICE (UHC MA PLAN)" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 25096-MD023032E . This is a "HEALTH PARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 360001506 . This is a "RRM" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0061867000 . This is a "IBC - PC/KHPE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0061867000 . This is a "AMERIHEALTH/INTERCOUNTY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 031534 . This is a "AETNA HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1030045 . This is a "KEYSTONE MERCY (MA)" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 4100067 . This is a "AETNA PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000983325 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 111167 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 350716 . This is a "PHCS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0309630 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7162918 . This is a "CIGNA HMO/PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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