Basic Information
Provider Information
NPI: 1538427406
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GRAUL
FirstName: ASHLEY
MiddleName: BROOKE
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 701 OSTRUM ST STE 502
Address2:  
City: FOUNTAIN HILL
State: PA
PostalCode: 180151153
CountryCode: US
TelephoneNumber: 4845267555
FaxNumber: 4845034501
Practice Location
Address1: 701 OSTRUM ST STE 502
Address2:  
City: FOUNTAIN HILL
State: PA
PostalCode: 180151153
CountryCode: US
TelephoneNumber: 4845267555
FaxNumber: 4845037001
Other Information
ProviderEnumerationDate: 04/30/2012
LastUpdateDate: 07/08/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000XMT201379PAN Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 
390200000XMT201379PAN Student, Health CareStudent in an Organized Health Care Education/Training Program 
207VX0201XMD457669PAY Allopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology

No ID Information.


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