Basic Information
| Provider Information | |||||||||
| NPI: | 1235398355 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAURENCE | ||||||||
| FirstName: | GRAHAM | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 429 N 21ST ST | ||||||||
| Address2: | |||||||||
| City: | CAMP HILL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170112202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177617244 | ||||||||
| FaxNumber: | 7177612055 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 PINE GROVE CMNS | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174035176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178516110 | ||||||||
| FaxNumber: | 7177411076 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2008 | ||||||||
| LastUpdateDate: | 03/24/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MD456389 | PA | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0127X | MD456389 | PA | N | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery | 2086S0102X | MD456389 | PA | Y | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care |
ID Information
| ID | Type | State | Issuer | Description | 103130736 | 05 | PA | MEDICAID | PO1831813 | 01 | PA | RAILROAD MEDICARE | OTHER |