Basic Information
| Provider Information | |||||||||
| NPI: | 1982680575 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRAEF | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 147 MILK STREET | ||||||||
| Address2: | PROVIDER ENROLLMENT - 9TH FLOOR | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021094862 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6175598053 | ||||||||
| FaxNumber: | 6174213487 | ||||||||
| Practice Location | |||||||||
| Address1: | 333 LONGWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021155711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6173558263 | ||||||||
| FaxNumber: | 6172778934 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 33948 | MA | X | Allopathic & Osteopathic Physicians | Pediatrics | 2080T0002X | 33948 | MA | X | Allopathic & Osteopathic Physicians | Pediatrics | Medical Toxicology | 208M00000X | 33948 | MA | X | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | V02406 | 01 | MA | BLUE CROSS | OTHER | PP624 | 01 | MA | HARVARD PILGRIM | OTHER | 0003908 | 01 | MA | NEIGHBORHOOD HEALTH | OTHER | 2020785 | 05 | MA | MEDICAID | 4147717-003 | 01 | MA | CIGNA | OTHER | 715698 | 01 | MA | TUFTS | OTHER |