Basic Information
| Provider Information | |||||||||
| NPI: | 1245314103 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRABIAS | ||||||||
| FirstName: | STANLEY | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2201 RIDGEWOOD RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | WYOMISSING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 196101189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103756226 | ||||||||
| FaxNumber: | 6103756200 | ||||||||
| Practice Location | |||||||||
| Address1: | 2201 RIDGEWOOD RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | WYOMISSING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 196101189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103756226 | ||||||||
| FaxNumber: | 6103756200 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2006 | ||||||||
| LastUpdateDate: | 02/22/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | MD12376E | PA | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 0730278 | 05 | PA | MEDICAID |