Provider Demographics
NPI:1295788503
Name:GRAFF, NIRUTISAI K (MD)
Entity type:Individual
Prefix:
First Name:NIRUTISAI
Middle Name:K
Last Name:GRAFF
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 1:4131 OREGON PIKE
Mailing Address - Street 2:SUITE C
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-9550
Mailing Address - Country:US
Mailing Address - Phone:717-859-5161
Mailing Address - Fax:717-859-5169
Practice Address - Street 1:175 MARTIN AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-1761
Practice Address - Country:US
Practice Address - Phone:717-721-5800
Practice Address - Fax:717-721-5858
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD635242086S0122X
PAMD430668208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA111124UFWOtherMEDICARE
PA1019750900001Medicaid
MD408404700Medicaid
PA111124UFWOtherMEDICARE
PA111124UFWOtherMEDICARE