Basic Information
Provider Information | |||||||||
NPI: | 1114917465 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GRAZIANO | ||||||||
FirstName: | JOSEPH | ||||||||
MiddleName: | A | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 250 DEBARTOLO PL | ||||||||
Address2: | SUITE 2750 | ||||||||
City: | YOUNGSTOWN | ||||||||
State: | OH | ||||||||
PostalCode: | 445127004 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3307587703 | ||||||||
FaxNumber: | 3307584930 | ||||||||
Practice Location | |||||||||
Address1: | 250 DEBARTOLO PL | ||||||||
Address2: | SUITE 2750 | ||||||||
City: | YOUNGSTOWN | ||||||||
State: | OH | ||||||||
PostalCode: | 445127004 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3307587703 | ||||||||
FaxNumber: | 3307584930 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/27/2005 | ||||||||
LastUpdateDate: | 01/10/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 35065910 | OH | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0000X | MD065190L | PA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207R00000X | 35065910 | OH | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 01699065 | 05 | PA |   | MEDICAID | 0211934 | 05 | OH |   | MEDICAID |